Pharmacokinetic-pharmacodynamic aspects of antimicrobial prophylaxis with teicoplanin in patients undergoing major vascular surgery

Abstract A prospective, two-arm, open study assessing plasma exposure to teicoplanin with two different prophylactic regimens (Group A ( n =23), 800mg pre-operatively versus Group B ( n =24), 400mg pre-operatively plus two doses of 200mg 24h apart) was carried out in patients undergoing major vascular surgery. The intent was to define the feasibility and the possible advantages of the single pre-operative high dose in ensuring therapeutically effective plasma concentrations (>10mg/L) of teicoplanin even during long-lasting operations. At the end of the intervention, mean teicoplanin concentrations (±S.D.) were 14.05±5.13mg/L and 5.39±2.13mg/L in Groups A and B, respectively. At 24h, average teicoplanin levels were 5.10±1.25mg/L and 2.08±0.73mg/L in Groups A and B, respectively; at 48h they declined to 2.86±0.70mg/L in Group A, whereas they rose to 2.67±0.82mg/L after administration of 2.63±0.51mg/kg at 24h in Group B. Single pre-operative high-dose teicoplanin may ensure effective plasma levels even in cases of very long-lasting operations (>8h) with no need for intraoperative re-dosing and may enable more appropriate prophylactic exposure than that achievable with the same total dose given in three administrations 24h apart.