Glycopeptide Antibiotic Pregnancy: Use only if clearly necessary — limited human data

Teicoplanin (Orthopaedic Bone and Joint Infections)

Brand names: Targocid

Adult dose

Dose: Loading: 400 mg IV every 12 hours × 3 doses; Maintenance: 400–800 mg IV or IM once daily

Route: Intravenous or Intramuscular

Frequency: Once daily (maintenance)

Max: 800 mg/day (severe infections including bone and joint)

Use 800 mg/day loading and maintenance for bone, joint, and severe infections (IDSA guidance). Teicoplanin can be given IM unlike vancomycin — advantage for outpatient parenteral antibiotic therapy (OPAT). Trough target ≥20 mg/L for bone/joint infections.

Paediatric dose

Dose: 10 mg/kg

Route: IV

Frequency: Every 12 hours × 3 doses (loading), then once daily

Max: 400 mg/day maintenance

Paediatric MRSA bone and joint infection — under specialist guidance; neonates: loading 16 mg/kg, then 8 mg/kg once daily

Dose adjustments

Renal

Accumulates in renal impairment — extend dosing interval to every 48–72 hours based on eGFR; trough monitoring mandatory

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Patient weight (kg)

Paediatric MRSA bone and joint infection — under specialist guidance; neonates: loading 16 mg/kg, then 8 mg/kg once daily

Clinical pearls

Advantage over vancomycin: teicoplanin can be given IM and once daily — ideal for OPAT (outpatient parenteral antibiotic therapy) in chronic osteomyelitis or PJI; patients can self-administer at home or attend community nursing
Trough level monitoring for bone and joint infections: target ≥20 mg/L — ensure adequate bone penetration; bone concentrations are 30–50% of serum concentrations (adequate for susceptible organisms)
Cross-reactivity with vancomycin: approximately 10% cross-allergy — in true vancomycin allergy (not Red Man Syndrome), teicoplanin may still be used with caution and allergy testing
Red Man Syndrome: teicoplanin can also cause infusion-related flushing — slow infusion over 30 minutes; less common than with vancomycin
Staphylococcus aureus glycopeptide MIC: EUCAST breakpoints — susceptible ≤2 mg/L for vancomycin and ≤2 mg/L for teicoplanin; some VISA/VRSA strains show reduced teicoplanin susceptibility independently of vancomycin

Contraindications

Known hypersensitivity to teicoplanin or vancomycin (cross-allergy in ~10%)

Side effects

Nephrotoxicity — less than vancomycin but still relevant
Ototoxicity — less commonly reported than vancomycin
Thrombocytopenia — monitor platelet count
Elevated LFTs
Injection site reactions (IM)

Interactions

Aminoglycosides — additive nephrotoxicity; avoid concurrent use if possible
Loop diuretics — additive ototoxicity

Monitoring

Teicoplanin trough levels (pre-dose at steady state — day 4+); target ≥20 mg/L for osteomyelitis
Renal function
FBC (platelet count — thrombocytopenia)
LFTs
Audiometry if prolonged use

Reference: BNFc; BNF 90; IDSA Osteomyelitis Guidelines 2012; BSAC OPAT Guidelines; EUCAST Breakpoints; SPC Targocid. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

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