Behring Alessandra Helen, Mariani Chiara, Gerbi Martina, Offer Martina, Matone Maddalena, Cattaneo Dario, Giacomelli Andrea, Colaneri Marta, Giorgi Riccardo, Merli Stefania, Piconi Stefania, Antinori Spinello, Gori Andrea, Passerini Matteo
Department of Infectious diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, via GB Grassi 74, Milan, Italy.
Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via GB Grassi 74, 20157 Milan, Italy.
J Antimicrob Chemother. 2025 Jun 3;80(6):1535-1542. doi: 10.1093/jac/dkaf097.
To assess the appropriateness of teicoplanin loading dose and therapeutic drug monitoring (TDM) in single-daily regimen (SDR) versus thrice-weekly regimen (TWR), and to compare safety and effectiveness.
This single-centre observational retrospective cohort study included adult patients treated with TDM-based teicoplanin for infections between April 2015 and December 2021. Appropriateness of loading dose and TDM, adverse events (AEs) and clinical outcomes were evaluated. A post hoc analysis assessed achievement of target TDM concentrations following appropriate loading dose.
Among 183 patients (103 SDR, 80 TWR), appropriate loading doses were less frequent in the SDR group [33/103 (35.9%, missing = 11) versus 56/80 (72.7%, missing = 3); P < 0.001]. First TDM was less commonly performed as recommended in the SDR group on Day 4 [89/103 (86.4%) versus 79/80 (98.8%); P = 0.002] and on Day 7 [31/103 (30.1%) versus 47/80 (58.8%); P < 0.001]. No significant differences were observed in AEs [15/103 (14.6%) versus 8/80 (10%); P = 0.38] or clinical success [60/103 (58.3%) versus 49/80 (61.3%); P = 0.681] between groups. Post hoc analysis showed that 2/16 (13%) patients with deep infections and 9/11 (82%) with non-deep infections on a TWR achieved target concentrations after loading dose.
Higher adherence to loading dose and TDM recommendations was observed for TWR compared with SDR. However, the TWR often failed to achieve adequate TDM levels for higher targets, highlighting the need for optimized TWR loading dose strategies.
评估替考拉宁负荷剂量及治疗药物监测（TDM）在单日给药方案（SDR）与每3周给药一次方案（TWR）中的合理性，并比较两者的安全性和有效性。
这项单中心观察性回顾性队列研究纳入了2015年4月至2021年12月期间接受基于TDM的替考拉宁治疗感染的成年患者。评估了负荷剂量和TDM的合理性、不良事件（AE）及临床结局。事后分析评估了适当负荷剂量后目标TDM浓度的达成情况。
183例患者中（103例采用SDR，80例采用TWR），SDR组中适当负荷剂量的频率较低[33/103（35.9%，缺失=11）对56/80（72.7%，缺失=3）；P<0.001]。SDR组在第4天[89/103（86.4%）对79/80（98.8%）；P=0.002]和第7天[31/103（30.1%）对47/80（58.8%）；P<0.001]按照推荐进行首次TDM的情况较少见。两组在AE[15/103（14.6%）对8/80（10%）；P=0.38]或临床成功率[60/103（58.3%）对49/80（61.3%）；P=0.681]方面未观察到显著差异。事后分析显示，TWR方案中2/16（13%）例深部感染患者和9/11（82%）例非深部感染患者在负荷剂量后达到了目标浓度。
与SDR相比，TWR对负荷剂量和TDM建议的依从性更高。然而，TWR方案对于较高目标常常未能达到足够的TDM水平，这突出表明需要优化TWR的负荷剂量策略。
