Glycopeptide Antibiotic — MRSA / Gram-Positive Infections Pregnancy: Use with caution — limited data; use only if clearly indicated

Teicoplanin

Brand names: Targocid

Adult dose

Dose: Loading: 400 mg IV every 12 hours × 3 doses; Maintenance: 400 mg IV/IM once daily; MRSA bacteraemia/endocarditis: 10 mg/kg every 12 hours × 3 doses then 10 mg/kg once daily

Route: Intravenous or intramuscular

Frequency: Loading then once daily

Max: 1200 mg/day (high-dose regimens for deep-seated infections)

Glycopeptide alternative to vancomycin. Advantage: once-daily IM/IV dosing — suitable for OPAT; less nephrotoxic than vancomycin. Trough monitoring essential. Loading dose mandatory to achieve therapeutic levels rapidly. For endocarditis/deep infections: target trough 15–20 mg/L.

Paediatric dose

Dose: 10 mg/kg IV every 12 hours × 3 loading doses, then 10 mg/kg once daily mg/kg

Route: IV

Frequency: As above

Max: 400 mg/dose

BNFc: licensed in children; neonates — 16 mg/kg loading, then 8 mg/kg once daily

Dose adjustments

Renal

Days 4–7: extend interval to every 48 hours; after day 7: every 72 hours in severe renal impairment; monitor trough levels

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Patient weight (kg)

BNFc: licensed in children; neonates — 16 mg/kg loading, then 8 mg/kg once daily

Clinical pearls

Teicoplanin can be given IM (unlike vancomycin) and as IV bolus — does not cause red man syndrome with rapid infusion
OPAT: preferred glycopeptide for outpatient IV — once-daily IM injection feasible; vancomycin requires continuous infusion or frequent boluses
Trough monitoring: sample pre-dose on day 4 onwards; target trough: uncomplicated infections 10–15 mg/L; endocarditis/osteomyelitis 15–20 mg/L
VRE (vancomycin-resistant Enterococcus): teicoplanin active against VanB but NOT VanA strains — check sensitivities
Less nephrotoxic than vancomycin — preferred when concurrent aminoglycosides or nephrotoxins required

Contraindications

Glycopeptide hypersensitivity

Side effects

Nephrotoxicity (less than vancomycin)
Ototoxicity (rare)
Red man syndrome (less than vancomycin — can give IV bolus)
Injection site reactions (IM)
Thrombocytopaenia
Elevated LFTs
Rash

Interactions

Aminoglycosides — additive nephrotoxicity and ototoxicity
Loop diuretics — additive ototoxicity
Nephrotoxic drugs — additive

Monitoring

Trough levels (day 4 pre-dose)
Renal function
FBC (thrombocytopaenia)
LFTs
Audiometry (prolonged courses)

Reference: BNFc; BNF 90; PHE Teicoplanin TDM Guidelines; BSAC Teicoplanin Guidelines; NICE NG-MRSA Management. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways