Asumang John, Heard Katie L, Troise Oliver, Fahmy Sandra, Mughal Nabeela, Moore Luke S P, Hughes Stephen
School of Medicine, Imperial College, London, SW7 2DD, UK.
Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
JAC Antimicrob Resist. 2021 Feb 21;3(1):dlab012. doi: 10.1093/jacamr/dlab012. eCollection 2021 Mar.
The glycopeptide teicoplanin is commonly utilized to facilitate outpatient parenteral antimicrobial therapy (OPAT). Licensed for once daily maintenance dosing, teicoplanin's long half-life allows for less frequent dosing (e.g. thrice weekly) following successful loading. This service evaluation reviews the safety and effectiveness of a novel thrice weekly teicoplanin dosing regimen.
A retrospective, observational study was conducted at Chelsea and Westminster Hospital (March 2018 to July 2020), evaluating trough serum teicoplanin concentrations for patients receiving >5 days of teicoplanin in the OPAT setting. Teicoplanin dosing and administration (once daily versus thrice weekly), clinical outcomes and therapeutic levels were analysed for all patients. The project was registered with clinical governance locally.
A total of 82 patients treated with teicoplanin in the OPAT service were included; 53/82 receiving thrice weekly and 29/82 receiving once daily dosing. Mean teicoplanin trough levels were similar in both groups (26.2 mg/L and 25.8 mg/L in once daily and thrice weekly groups, =0.8895). High clinical success rates were recorded in both groups (25/29 [86.2%] versus 50/53 [94.3%]). No correlation with clinical outcomes and initial teicoplanin serum levels was identified. Normal renal function (>90 mL/min) was associated with lower teicoplanin serum concentrations (mean [±SD] 21.4 mg/L [±10.1] versus 29.7 mg/L [±14], =0.0178) in the thrice weekly dosed group but not with the once daily dosed group (mean [±SD] 28.2 mg/L [±9.4] versus 23.7 mg/L [±9.9], =0.2201).
This study supports thrice weekly teicoplanin as a convenient and effective OPAT for administration in the OPAT setting. Therapeutic drug monitoring is advised to adjust for intra-patient variability.
糖肽类药物替考拉宁常用于促进门诊胃肠外抗菌治疗（OPAT）。替考拉宁获批每日一次维持给药，其较长的半衰期使得在成功负荷给药后可减少给药频率（如每周三次）。本服务评估回顾了一种新型的替考拉宁每周三次给药方案的安全性和有效性。
在切尔西和威斯敏斯特医院进行了一项回顾性观察研究（2018年3月至2020年7月），评估在OPAT环境中接受替考拉宁治疗超过5天的患者的替考拉宁血清谷浓度。分析了所有患者的替考拉宁给药和用药情况（每日一次与每周三次）、临床结局和治疗水平。该项目在当地进行了临床治理登记。
共有82例在OPAT服务中接受替考拉宁治疗的患者纳入研究；82例中有53例接受每周三次给药，29例接受每日一次给药。两组的替考拉宁平均谷浓度相似（每日一次组和每周三次组分别为26.2mg/L和25.8mg/L，P = 0.8895）。两组均记录到较高的临床成功率（25/29 [86.2%] 对50/53 [94.3%]）。未发现临床结局与初始替考拉宁血清水平之间存在相关性。在每周三次给药组中，肾功能正常（>90mL/min）与较低的替考拉宁血清浓度相关（平均[±标准差] 21.4mg/L [±10.1] 对29.7mg/L [±14]，P = 0.0178），但在每日一次给药组中无相关性（平均[±标准差] 28.2mg/L [±9.4] 对23.7mg/L [±9.9]，P = 0.2201）。
本研究支持每周三次替考拉宁作为一种在OPAT环境中方便有效的OPAT给药方式。建议进行治疗药物监测以调整患者个体差异。
