Antibiotic — Glycopeptide Pregnancy: Use with caution — limited data; avoid unless no alternative for MRSA in pregnancy

Teicoplanin (Burns — MRSA Alternative)

Brand names: Targocid

Adult dose

Dose: Loading: 6 mg/kg IV every 12 hours × 3 doses; Maintenance: 6 mg/kg IV once daily

Route: IV or IM

Frequency: Once daily (maintenance)

Max: 12 mg/kg/day in severe infection

Alternative to vancomycin for MRSA burns infection — once-daily dosing advantage. Longer half-life allows IM administration (useful if limited IV access). Target trough >15 mg/L for serious infections (>20 mg/L for endocarditis/osteomyelitis). Longer loading phase than vancomycin.

Paediatric dose

Dose: 10 mg/kg

Route: IV

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

Max: 400 mg/dose

Loading: 10 mg/kg every 12 hours × 3; maintenance 6–10 mg/kg once daily. Neonates: 16 mg/kg first dose then 8 mg/kg once daily.

Dose adjustments

Renal

Reduce dose frequency after 4th day: every 48h if eGFR 30–60; every 72h if eGFR <30.

Hepatic

No specific adjustment.

Paediatric weight-based calculator

Patient weight (kg)

Loading: 10 mg/kg every 12 hours × 3; maintenance 6–10 mg/kg once daily. Neonates: 16 mg/kg first dose then 8 mg/kg once daily.

Clinical pearls

Advantage over vancomycin: once-daily dosing, IM route possible, less nephrotoxicity, less Red man syndrome risk
Therapeutic drug monitoring: trough 15–20 mg/L for serious skin/soft tissue infection; 20–30 mg/L for bone/joint or endocarditis
Vancomycin-allergic patients: teicoplanin 10% cross-reactive — use with caution and under allergy specialist guidance if severe penicillin allergy

Contraindications

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

Side effects

Nephrotoxicity (less than vancomycin)
Ototoxicity (less than vancomycin)
Red man syndrome (rare — less common than with vancomycin)
Thrombocytopenia
Raised LFTs

Interactions

Aminoglycosides (additive nephrotoxicity/ototoxicity)
Loop diuretics (additive ototoxicity)

Monitoring

Teicoplanin trough levels (sample pre-4th dose)
Renal function
Platelet count
LFTs

Reference: BNFc; BNF 90; BSAC/EUCAST Glycopeptide Guidelines; BBA Burns Infection Guidelines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Vancomycin (Burns — MRSA) · Antibiotic — Glycopeptide