Teicoplanin: Brands, Price & Uses in Bangladesh

Teicoplanin is a glycopeptide antibiotic indicated for the treatment of serious infections caused by susceptible Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), particularly when penicillins or cephalosporins are inappropriate, ineffective, or not tolerated.

Established / guideline-supported uses

• Complicated skin and soft tissue infections
• Bone and joint infections (e.g., osteomyelitis, septic arthritis)
• Hospital-acquired and community-acquired pneumonia caused by susceptible Gram-positive organisms
• Infective endocarditis caused by susceptible Gram-positive organisms (often as part of combination therapy)
• Complicated urinary tract infections
• Peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD)

Adjunct / combination uses

• Empirical therapy of febrile neutropenia, used in combination with other antibacterial agents when Gram-positive infection is suspected
• Antibiotic prophylaxis during major surgery (e.g., orthopaedic surgery) in patients at high risk of Gram-positive infection, especially when beta-lactam allergy is present

Off-label use

Clostridioides difficile-associated diarrhoea/colitis (oral Teicoplanin) has been used off-label as an alternative to oral vancomycin in some settings, though this is not a primary approved indication everywhere.

Teicoplanin should only be used for infections confirmed or strongly suspected to be caused by susceptible Gram-positive organisms; it is not effective against Gram-negative bacteria.

Teicoplanin is administered by intravenous (IV) bolus injection over 3-5 minutes, IV infusion over about 30 minutes, or by intramuscular (IM) injection, according to the clinical situation. Dosing typically begins with loading doses to rapidly achieve therapeutic plasma concentrations, followed by a once-daily maintenance dose.

Adults and elderly with normal renal function

Renal impairment

No dose adjustment is usually needed for the first 3-4 days of therapy. From day 4 onward, maintenance dose adjustment based on creatinine clearance (CrCl) is required: approximately half the normal maintenance dose for moderate renal impairment (CrCl about 40-60 mL/min) and about one-third of the normal maintenance dose (or dosing every 2-3 days) for severe renal impairment (CrCl below 40 mL/min) or patients on haemodialysis. Therapeutic drug monitoring is recommended where available, especially in renal impairment and prolonged therapy.

Pediatric dosing

• Children (2 months to 12 years): 10 mg/kg every 12 hours for 3 doses, then 6-10 mg/kg once daily depending on infection severity.
• Neonates: 16 mg/kg as a single loading dose, then 8 mg/kg once daily.

Important: Take Teicoplanin exactly as prescribed by your physician; do not stop, extend, skip doses, or share this medicine with others without medical advice, as inappropriate use can lead to treatment failure and antibiotic resistance.

Most patients tolerate Teicoplanin well, but as with any antibiotic, side effects can occur.

Common

• Injection-site reactions: pain, redness (erythema), local swelling, or abscess formation
• Rash, pruritus (itching)
• Fever
• Nausea, vomiting, diarrhoea
• Headache, dizziness

Less common / serious

• Nephrotoxicity - impaired kidney function, more likely with high doses, prolonged use, pre-existing renal impairment, or concurrent nephrotoxic drugs
• Ototoxicity - tinnitus (ringing in ears), hearing disturbance, or balance problems, particularly with prolonged high-dose therapy
• Thrombocytopenia - low platelet count, generally reversible on stopping treatment
• Transient elevation of liver enzymes
• Infusion-related reactions (flushing, itching during rapid administration) - less frequently associated with the "red man syndrome" seen with vancomycin, but still possible
• Hypersensitivity reactions, including rare anaphylaxis
• Leukopenia, eosinophilia (rare)

Seek prompt medical attention for signs of a serious allergic reaction (swelling of the face/throat, difficulty breathing, severe rash), unusual bleeding or bruising, significant reduction in urine output, or new hearing/balance problems while receiving Teicoplanin.