Teicoplanin dosing strategy for treatment of Staphylococcus aureus in Korean patients with neutropenic fever

Purpose

The present study was conducted to determine and compare the target attainment rate (TAR) between microorganism-nonspecific (C_trough) and microorganism-specific (AUC₂₄/MIC) targets over two weeks of teicoplanin administration according to several dose regimens for the treatment of Staphylococcus aureus in Korean patients with neutropenic fever.

Materials and Methods

One thousand virtual concentrations were obtained for each dose using the population pharmacokinetic parameters of teicoplanin adopted from a published study. Simulation of 1,000 virtual MICs was performed using the MICs of 78 clinical isolates of S. aureus collected from a hospital in Korea. Thereafter, these simulated MICs were randomly allocated to 1,000 virtual patients in whom the TARs for AUC₂₄/MIC >125 or 345] and C_trough >10 or 20] mg/L were determined. The relationship of the maintenance dose with the steady-state TAR was predicted with respect to the AUC₂₄/MIC >125 or 345] using logistic analysis.

Results

The standard dose regimen of teicoplanin showed TARs of about 70% or 33%] and 70% or 20%] at steady-state in cases with AUC₂₄/MIC >125 or 345] and C_trough >10 or 20] mg/L, respectively.

Conclusion

The current standard dose regimen was predicted to be insufficient to adequately treat S. aureus in Korean patients with neutropenic fever. To assure at least an 80% TAR in this population, dose adjustment of teicoplanin should be considered.