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Yamada T, Emoto C, Fukuda T, et al. Optimal teicoplanin dosing regimen in neonates and children developed by leveraging real-world clinical information. Ther Drug Monit. 2021;doi: 10.1097/FTD.0000000000000930.
Yamada, T., Emoto, C., Fukuda, T., Motomura, Y., Inoue, H., Ohga, S., & Ieiri, I. (2021). Optimal teicoplanin dosing regimen in neonates and children developed by leveraging real-world clinical information. Therapeutic drug monitoring, . https://doi.org/10.1097/FTD.0000000000000930
Yamada, Takaaki, et al. "Optimal teicoplanin dosing regimen in neonates and children developed by leveraging real-world clinical information." Therapeutic drug monitoring vol. (2021). doi: https://doi.org/10.1097/FTD.0000000000000930
Yamada T, Emoto C, Fukuda T, Motomura Y, Inoue H, Ohga S, Ieiri I. Optimal teicoplanin dosing regimen in neonates and children developed by leveraging real-world clinical information. Ther Drug Monit. 2021 Oct 08; doi: 10.1097/FTD.0000000000000930. Epub 2021 Oct 08. PMID: 34629445.
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Ther Drug Monit. 2021 Oct 08; doi: 10.1097/FTD.0000000000000930. Epub 2021 Oct 08.

Optimal teicoplanin dosing regimen in neonates and children developed by leveraging real-world clinical information.

Therapeutic drug monitoring

Takaaki Yamada, Chie Emoto, Tsuyoshi Fukuda, Yoshitomo Motomura, Hirosuke Inoue, Shouichi Ohga, Ichiro Ieiri

Affiliations

  1. Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan Laboratory of Drug Metabolism and Pharmacokinetics, Showa Pharmaceutical University, Tokyo, Japan National Center for Child Health and Development, Tokyo, Japan Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

PMID: 34629445 DOI: 10.1097/FTD.0000000000000930

Abstract

BACKGROUND: Teicoplanin is a glycopeptide antibiotic used for the treatment of methicillin-resistant Staphylococcus aureus infections. To ensure successful target attainment, therapeutic drug monitoring-informed dosage adjustment is recommended. However, it relies on the experience of the clinician and the frequency of drug measurements. This study aimed to design a new optimal dosing regimen of teicoplanin with a maintenance dosing strategy for neonates and children based on their physiological characteristics.

METHODS: Data from teicoplanin-treated patients (n = 214) were collected from electronic medical records. Covariate analyses were performed using population pharmacokinetic (PK) modeling with 399 serum teicoplanin concentrations from 48 neonates and 166 children. Multiple PK simulations were conducted to explore optimal dosing regimens that would allow control of the trough concentration to the target of 15-30 mg/L quicker than the current standard regimen.

RESULTS: Allometrically scaled body weight, postmenstrual age (PMA), renal function, and serum albumin were implemented as substantial covariates for teicoplanin clearance in a two-compartment PK model. Covariate analyses and comprehensive simulation assessments recommended the following modifications to the current regimen: 1) decreased dose for premature babies (PMA ≤ 28 weeks), 2) decreased dose for children with renal dysfunction, and 3) increased dose for children (0.5-11 years) with an estimated glomerular filtration rate of ≥90 mL/min/1.73 m2.

CONCLUSIONS: This study leverages real-world clinical information and proposes new optimal dosing regimens for teicoplanin in neonates and children through PK modeling and simulation analyses, taking into account the age, including PMA, and renal function of patients.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Conflict of interest statement

Conflicts of Interest and Source of Funding: This work was supported by JSPS KAKENHI Grant Number JP18K14951. T.Y. was supported by a scholarship grant from the Japan Research Foundation for Clinical

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