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Glycopeptide Antibiotic Pregnancy: There are limited data from use in pregnant women. Animal studies have shown reproductive toxicity at high doses (increased stillbirths and neonatal mortality in rats); the potential risk for humans is unknown, so teicoplanin should not be used during pregnancy unless clearly necessary, and a potential risk of inner ear and renal damage to the foetus cannot be excluded. It is unknown whether teicoplanin is excreted in human milk; a decision on continuing breast-feeding or therapy should weigh the benefit of each. Animal reproduction studies have not shown impairment of fertility.

Teicoplanin (Orthopaedic Bone and Joint Infections)

Brand names: Targocid

Teicoplanin is a glycopeptide antibiotic given intravenously (or intramuscularly) for serious Gram-positive bone and joint infections, including MRSA, often as part of prolonged orthopaedic regimens.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Bone and joint infections (adults and elderly with normal renal function): loading dose 12 mg/kg body weight every 12 hours for 3 to 5 intravenous administrations, followed by a maintenance dose of 12 mg/kg body weight once a day
Route: Intravenous or intramuscular; the loading doses for bone and joint infections are given intravenously. Intravenous injection may be given either as a bolus over 3 to 5 minutes or as a 30-minute infusion
Frequency: Loading: every 12 hours for 3 to 5 doses. Maintenance: once a day
Max: Not stated as an absolute dose ceiling; treatment should not exceed 4 months
Fetched SPC: 'Targocid 200mg powder for solution for injection/infusion' (https://www.medicines.org.uk/emc/product/2926/smpc). The dose is to be adjusted on bodyweight whatever the weight of the patient. TARGET TROUGH CONCENTRATIONS for bone and joint infections: above 20 mg/L (FPIA) at day 3 to 5 after the loading regimen, and above 20 mg/L (FPIA) during maintenance. Trough serum concentrations should be monitored at steady state after completion of the loading dose regimen, and at least once a week during maintenance treatment to ensure concentrations are stable. General targets: for most Gram-positive infections at least 10 mg/L by HPLC or at least 15 mg/L by FPIA; for endocarditis and other severe infections 15 to 30 mg/L by HPLC or 30 to 40 mg/L by FPIA. DURATION: decided on clinical response; treatment should not exceed 4 months (for infective endocarditis a minimum of 21 days is usually considered appropriate). OTHER REGIMENS in the same table: complicated skin and soft tissue infections, pneumonia and complicated urinary tract infections — loading 6 mg/kg every 12 hours for 3 IV or IM administrations then 6 mg/kg IV or IM once a day, target trough above 15 mg/L (FPIA); infective endocarditis — loading 12 mg/kg every 12 hours for 3 to 5 IV administrations then 12 mg/kg IV or IM once a day, target trough 30 to 40 mg/L at day 3 to 5 and above 30 mg/L during maintenance. Clostridium difficile infection-associated diarrhoea and colitis: 100 to 200 mg orally twice a day for 7 to 14 days (oral route only for this indication). Teicoplanin has a limited (Gram-positive) spectrum and is not suitable as a single agent for some infections unless the pathogen is documented and known to be susceptible. Teicoplanin must NOT be administered by the intraventricular route. Infusion related reactions can be limited if the daily dose is infused over 30 minutes rather than given as a bolus. Elderly: no dose adjustment is required unless there is renal impairment.

Paediatric dose

Dose: 10 mg/kg
Route: Intravenous infusion (only the infusion method should be used in neonates)
Frequency: Loading: 10 mg/kg every 12 hours, repeated 3 times (children aged 2 months to 12 years), followed by once-daily maintenance
Max: Not stated for the paediatric population in this SPC
From SPC §4.2. Children 2 months to 12 years: loading dose one single dose of 10 mg/kg body weight intravenously every 12 hours, repeated 3 times; maintenance one single dose of 6 to 10 mg/kg body weight intravenously once a day (the maintenance figure is a range, so only the loading figure is recorded as dosePerKg). Neonates and infants up to the age of 2 months: loading dose one single dose of 16 mg/kg body weight by intravenous infusion on the first day, then maintenance one single dose of 8 mg/kg body weight by intravenous infusion once a day. Children above 12 years of age: the dose recommendations are the same as for adults. Only the infusion method should be used in neonates. Verify all paediatric dosing against a children's formulary before use.

Dose adjustments

Renal

Dose adjustment is not required until the fourth day of treatment, at which point dosing should be adjusted to maintain a serum trough concentration of at least 10 mg/L (HPLC) or at least 15 mg/L (FPIA). After the fourth day: in mild and moderate renal insufficiency (creatinine clearance 30 to 80 mL/min) the maintenance dose should be halved, either by giving the dose every two days or by giving half the dose once a day; in severe renal insufficiency (creatinine clearance less than 30 mL/min) and in haemodialysed patients the dose should be one-third of the usual dose, either by giving the initial unit dose every third day or one-third of the dose once a day. Teicoplanin is not removed by haemodialysis. In continuous ambulatory peritoneal dialysis: after a single intravenous loading dose of 6 mg/kg body weight, 20 mg/L is administered in the bag of dialysis solution in the first week, 20 mg/L in different bags in the second week, then 20 mg/L in the overnight bag in the third week.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

From SPC §4.2. Children 2 months to 12 years: loading dose one single dose of 10 mg/kg body weight intravenously every 12 hours, repeated 3 times; maintenance one single dose of 6 to 10 mg/kg body weight intravenously once a day (the maintenance figure is a range, so only the loading figure is recorded as dosePerKg). Neonates and infants up to the age of 2 months: loading dose one single dose of 16 mg/kg body weight by intravenous infusion on the first day, then maintenance one single dose of 8 mg/kg body weight by intravenous infusion once a day. Children above 12 years of age: the dose recommendations are the same as for adults. Only the infusion method should be used in neonates. Verify all paediatric dosing against a children's formulary before use.

Verify in a children's formulary

Contraindications

  • Hypersensitivity to teicoplanin or to any of the excipients

Side effects

  • Rash, erythema, pruritus, pain and pyrexia (common); red man syndrome, flushing of the upper part of the body (rare)
  • Diarrhoea, vomiting, nausea, dizziness and headache (common)
  • Leucopenia, thrombocytopenia and eosinophilia (common); agranulocytosis, neutropenia and pancytopenia (uncommon)
  • Increased blood creatinine (common) and renal failure including acute renal failure (uncommon) — confirmed nephrotoxicity was 11.0% over the first 10 days in a post-authorisation study of the high loading dose regimen of 12 mg/kg twice a day followed by 12 mg/kg once daily
  • Deafness, hearing loss, tinnitus and vestibular disorder (rare); anaphylactic reaction (uncommon), anaphylactic shock and DRESS (rare); toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalised exanthematous pustulosis, erythema multiforme, angioedema and exfoliative dermatitis (rare)

Clinical monograph

How it works

It inhibits bacterial cell-wall synthesis by binding the D-alanyl-D-alanine terminus of peptidoglycan precursors, blocking cross-linking in Gram-positive organisms.

Prescribing in practice

  • Adequate loading doses are essential to reach therapeutic levels quickly in deep bone and joint infection before maintenance dosing.
  • Reduce maintenance dosing in renal impairment and monitor for nephrotoxicity and ototoxicity, particularly with other nephrotoxic drugs.
  • Use under stewardship guidance, with trough-level monitoring to ensure adequate exposure in serious infection.

Monitoring

Monitor renal function, full blood count and trough serum concentrations, especially during prolonged therapy for bone and joint infection.

Counselling the patient

  • Treatment courses for bone infection are often prolonged and may continue at home or in an outpatient service.
  • Report rash, fever, or any change in hearing.
  • Attend for the blood tests used to keep the dose in the right range.

Evidence & guidelines

Teicoplanin is an established option for Gram-positive bone and joint infection in UK practice, with therapeutic drug monitoring recommended for serious infections.

Reference: IDSA Osteomyelitis Guidelines 2012; BSAC OPAT Guidelines; EUCAST Breakpoints; SPC Targocid; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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