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Glycopeptide Antibiotic Pregnancy: Use with caution — limited data; use only when clearly indicated for serious infection

Teicoplanin (Surgical Prophylaxis/MRSA)

Brand names: Targocid

Adult dose

Dose: Surgical prophylaxis: 400 mg IV single dose at induction; MRSA treatment: 6 mg/kg IV every 12h for 3 doses then 6 mg/kg every 24h
Route: IV (over 30 minutes) or IM
Frequency: Once daily (treatment); single dose (prophylaxis)
Max: 12 mg/kg/day in severe infections
Preferred over vancomycin for surgical prophylaxis in MRSA-colonised patients — once-daily dosing, less nephrotoxic than vancomycin, does not require infusion rate monitoring (no red man syndrome). Give 30–60 minutes before surgical incision.

Paediatric dose

Dose: 10 mg/kg
Route: IV
Frequency: Every 12h for 3 loading doses then every 24h
Max: 400 mg per dose
Neonates/children: 10 mg/kg every 12h for 3 doses then 10 mg/kg every 24h. BNFc guidance: neonates and children — seek specialist advice.

Dose adjustments

Renal

Reduce frequency after day 4: eGFR 40–60: dose every 48h; eGFR <40: every 72h. Monitor trough levels.

Hepatic

No dose adjustment required.

Paediatric weight-based calculator

Neonates/children: 10 mg/kg every 12h for 3 doses then 10 mg/kg every 24h. BNFc guidance: neonates and children — seek specialist advice.

Clinical pearls

  • MRSA surgical prophylaxis: teicoplanin is recommended in NICE NG125 (Surgical Site Infection Prevention) for MRSA-positive patients undergoing clean surgery involving prosthetics (joint replacement, cardiac surgery, vascular grafts)
  • Teicoplanin vs vancomycin for MRSA: teicoplanin has advantages of once-daily dosing, IM route option, and no requirement for rate-limited infusion; however, vancomycin has better PK/PD data and more evidence in BSI
  • Trough monitoring: therapeutic trough for serious infections (endocarditis, BSI) 15–30 mg/L; for less severe infections 10–15 mg/L; for prophylaxis single dose — no trough monitoring required

Contraindications

  • Hypersensitivity to glycopeptides (cross-sensitivity with vancomycin possible but not universal)

Side effects

  • Injection site reactions (IM)
  • Nephrotoxicity (less than vancomycin)
  • Ototoxicity (rare at standard doses)
  • Elevated LFTs
  • Thrombocytopenia (rare)
  • Red man syndrome (less common than vancomycin — slower release of histamine)

Interactions

  • Aminoglycosides (additive nephrotoxicity and ototoxicity — avoid concurrent use or monitor closely)
  • Loop diuretics (additive ototoxicity)
  • Ciclosporin/tacrolimus (additive nephrotoxicity)

Monitoring

  • Trough levels (for multi-day treatment — not prophylaxis)
  • Renal function (creatinine, eGFR)
  • Full blood count (thrombocytopenia)
  • LFTs

Reference: BNFc; BNF 90; NICE NG125 (Surgical Site Infection); BNFc; PHE Antimicrobial Stewardship Guidelines; MHRA SPC Targocid. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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