Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy · 2026
Effect of body composition on initial teicoplanin dosing and optimization of the regimen.
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Kondo Shoji, Oda Kazutaka, Jono Hirofumi
Аннотация
BACKGROUND: Teicoplanin dosing in obese or underweight patients is uncertain due to its unique pharmacokinetic variability, potentially resulting in suboptimal exposure. This study seeks to establish a dosing strategy tailored to body composition by assessing the initial teicoplanin dosing regimen using different weight indices alongside actual body weight (ABW).
METHODS: This retrospective study involved adult patients who were administered intravenous teicoplanin at Kumamoto University Hospital between 2017 and 2023. The ratio of initial trough concentration (μg/mL, C) to the total teicoplanin loading dose administered within 24 h (mg/kg/24 h, D) was evaluated based on body composition.
RESULTS: A total of 160 patients were included in the analysis. The mean C/D ratios were 0.42 ± 0.13, 0.52 ± 0.14, and 0.66 ± 0.14 in patients classified as underweight (BMI: <18.5 kg/m2, n = 32), normal weight (BMI: 18.5 to <25 kg/m2, n = 88), and obese (BMI: ≥25 kg/m2, n = 40), respectively (P < 0.001, Tukey's honestly significant difference test). Bayesian-predicted pharmacokinetic parameters indicated that the smallest prediction errors were observed when ABW was used for underweight and normal-weight patients (43.8 ± 5.5 kg and 56.0 ± 7.2 kg, respectively). In contrast, standard body weight (SBW) and ideal body weight (IBW) yielded the lowest errors in obese patients.
CONCLUSIONS: Teicoplanin loading doses should be increased by ∼20% in underweight patients and decreased by ∼20% in obese patients compared to those in normal-weight patients. SBW- or IBW-based dosing is recommended in obese patients to prevent overexposure.
METHODS: This retrospective study involved adult patients who were administered intravenous teicoplanin at Kumamoto University Hospital between 2017 and 2023. The ratio of initial trough concentration (μg/mL, C) to the total teicoplanin loading dose administered within 24 h (mg/kg/24 h, D) was evaluated based on body composition.
RESULTS: A total of 160 patients were included in the analysis. The mean C/D ratios were 0.42 ± 0.13, 0.52 ± 0.14, and 0.66 ± 0.14 in patients classified as underweight (BMI: <18.5 kg/m2, n = 32), normal weight (BMI: 18.5 to <25 kg/m2, n = 88), and obese (BMI: ≥25 kg/m2, n = 40), respectively (P < 0.001, Tukey's honestly significant difference test). Bayesian-predicted pharmacokinetic parameters indicated that the smallest prediction errors were observed when ABW was used for underweight and normal-weight patients (43.8 ± 5.5 kg and 56.0 ± 7.2 kg, respectively). In contrast, standard body weight (SBW) and ideal body weight (IBW) yielded the lowest errors in obese patients.
CONCLUSIONS: Teicoplanin loading doses should be increased by ∼20% in underweight patients and decreased by ∼20% in obese patients compared to those in normal-weight patients. SBW- or IBW-based dosing is recommended in obese patients to prevent overexposure.