Teicoplanin pharmacokinetics in critically ill patients on continuous veno-venous hemofiltration

Pharmacokinetics of teicoplanin (TP) was assessed in critically ill patients on continuous veno-venous hemofiltration (CVVH), in eleven patients, after the first dose and in another four after repeated administration. The TP peak concentration amounted to 55.44 +/- 15.90 mu g/ml and 81.28 +/- 28.55 mu g/ml (mean +/- SD), the trough concentration 6.4 +/- 1.7 mu g/ml and 21.3 +/- 5.0 mu g/ml, the half-life 15.7 +/- 5.7 and 35.1 +/- 12.3 h, the apparent volume of distribution 0.84 +/- 0.22 and 0.48 +/- 0.09 l/kg and the TP clearance 39 +/- 12 and 11 +/- 4 ml/h/kg after the first close and after repeated administration, respectively. The mean sieving coefficient of TP was 0.15. After a 1,200 mg loading dose, daily maintenance doses of 600 - 1,800 mg were required for achieving trough levels of 15 - 25 mu g/ml. Therapeutic drug monitoring is indispensable during CVVH because of a considerable variability of TP pharmacokinetics.