Teicoplanin (Burns — MRSA Alternative)

How it works

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

Prescribing in practice

• Adequate loading doses are essential because therapeutic concentrations are reached slowly; under-loading risks treatment failure in serious burns sepsis.
• The large fluid shifts and increased drug clearance of major burns alter pharmacokinetics, so therapeutic drug monitoring of trough levels is advised to ensure adequate exposure.
• Use caution with concurrent nephrotoxic or ototoxic agents and in renal impairment, where dose adjustment is required.

Monitoring

Monitor trough serum concentrations, renal function and full blood count, since burns increase clearance and may necessitate higher exposure targets.

Counselling the patient

• This is a glycopeptide used when resistant Gram-positive infection is suspected or confirmed.
• Blood levels are checked to make sure the dose is high enough in the burns setting.
• Report rash, hearing changes or reduced urine output.

Evidence & guidelines

Teicoplanin is an established glycopeptide alternative to vancomycin for serious Gram-positive infection, with altered burns pharmacokinetics well described.