Antibiotic — Glycopeptide Pregnancy: Limited data in pregnant women; animal studies showed reproductive toxicity at high doses (increased stillbirths and neonatal mortality in rats). Should not be used during pregnancy unless clearly necessary; 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 — decide on continuing/discontinuing breast-feeding or therapy weighing the benefits of each.

Teicoplanin (Burns — MRSA Alternative)

Brand names: Targocid

Teicoplanin is a glycopeptide antibacterial used in burns for Gram-positive infection, including meticillin-resistant Staphylococcus aureus, valued as an alternative to vancomycin because once-daily maintenance dosing and intramuscular or rapid intravenous administration suit complex burns care.

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: Complicated skin and soft tissue infections: loading dose 6 mg/kg body weight every 12 hours for 3 administrations, then maintenance 6 mg/kg body weight once a day

Route: Intravenous or intramuscular. The 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 doses. Maintenance: once daily

Source: UK SPC (eMC) for Targocid 200mg powder for solution for injection/infusion, §4.2 (https://www.medicines.org.uk/emc/product/2926/smpc). The SPC has no burns-specific indication; the regimen above is the SPC's 'complicated skin and soft tissue infections' row (which also covers pneumonia and complicated UTI) — clinician to confirm against local burns/MRSA protocol. The dose is to be adjusted on bodyweight whatever the weight of the patient. TROUGH MONITORING: monitor trough serum concentrations at steady state after completion of the loading dose regimen — 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 15-30 mg/L by HPLC or 30-40 mg/L by FPIA. During maintenance, trough monitoring may be performed at least once a week. OTHER INDICATIONS (§4.2): bone and joint infections — 12 mg/kg every 12 hours for 3 to 5 intravenous administrations, then 12 mg/kg IV or IM once daily (target trough >20 mg/L by FPIA); infective endocarditis — 12 mg/kg every 12 hours for 3 to 5 intravenous administrations, then 12 mg/kg once daily (target 30-40 mg/L at day 3-5, >30 mg/L during maintenance), minimum 21 days usually appropriate. Clostridium difficile infection-associated diarrhoea and colitis: 100-200 mg orally twice a day for 7 to 14 days (oral route to be used for this indication only). DURATION: decided on clinical response; treatment should not exceed 4 months. COMBINATION THERAPY: teicoplanin has a limited (Gram-positive) spectrum and is not suitable as a single agent for some infection types unless the pathogen is documented/known to be susceptible. Elderly: no dose adjustment required unless renal impairment. Should not be administered by intraventricular use (§4.4). CAPD patients: after a single IV loading dose of 6 mg/kg, 20 mg/L is administered in the bag of dialysis solution in the first week, 20 mg/L in different bags the second week, then 20 mg/L in the overnight bag in the third week.

Paediatric dose

Dose: 10 mg/kg

Route: Intravenous

Frequency: Children 2 months to 12 years — loading: 10 mg/kg every 12 hours, repeated 3 times; maintenance: 6-10 mg/kg once daily

Max: No paediatric maximum dose is stated in §4.2

SPC §4.2 paediatric population. dosePerKg above is the stated single loading dose for children 2 months to 12 years; the maintenance dose is a range (6-10 mg/kg once daily). NEONATES AND INFANTS UP TO 2 MONTHS: loading one single dose of 16 mg/kg body weight IV by infusion on the first day; maintenance one single dose of 8 mg/kg IV by infusion once a day. Only the infusion method should be used in neonates. CHILDREN ABOVE 12 YEARS: dose recommendations are the same as in adults. Verify all paediatric dosing against a children's formulary before administration.

Dose adjustments

Renal

Dose adjustment is not required until the fourth day of treatment, at which time dosing should be adjusted to maintain a serum trough of at least 10 mg/L (HPLC) or at least 15 mg/L (FPIA). After the fourth day: mild and moderate renal insufficiency (creatinine clearance 30-80 mL/min) — halve the maintenance dose, either by giving the dose every two days or half the dose once a day; severe renal insufficiency (creatinine clearance <30 mL/min) and haemodialysed patients — 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.

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

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to teicoplanin or to any of the excipients

Side effects

Common: rash, erythema, pruritus; pain, pyrexia
Common: diarrhoea, vomiting, nausea; dizziness, headache
Common: leucopenia, thrombocytopenia, eosinophilia; transient increases in transaminases and alkaline phosphatase
Uncommon/rare: anaphylactic reaction and anaphylactic shock, DRESS, red man syndrome, bronchospasm, angioedema
Rare/not known: deafness and hearing loss, tinnitus, vestibular disorder; blood creatinine increased and renal failure (including acute renal failure); Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis

Clinical monograph

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.

Reference: BSAC/EUCAST Glycopeptide Guidelines; BBA Burns Infection Guidelines; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Vancomycin (Burns — MRSA) · Antibiotic — Glycopeptide