Teicoplanin (Orthopaedic Bone and Joint Infections)

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.