Early Therapeutic Drug Monitoring Optimizes Teicoplanin Use in Patients with Hematological Malignancies

Abstract

Abstract Purpose Teicoplanin is a time-dependent glycopeptide antibiotic. The trough concentration (Cmin) ≥ 15–20 mg/L between the fourth and sixth day has been suggested for severe infections or the management of febrile neutropenia (FN). Owing to no reports discussing the impact of early target attainment on treatment outcomes, this study aimed to evaluate the dose–Cmin relationship and clinical outcome and estimate the optimal early target Cmin for FN in patients with hematological malignancies Methods This single-center, prospective study enrolled hematological malignancy patients who were treated with teicoplanin either as an empirical antibiotic for FN or as definitive treatment for Gram-positive bacteria. Blood samples were collected on day three (48 hours) post-loading doses, day five (96 hours), and day eight (when applicable) and determined by ultra high pressure liquid chromatography-triple quadruple mass spectrometry. A two-tailed α value of 0.05 was considered as statistical significance. Results A total of 117 samples from 47 FN patients were consecutively analyzed. The mean Cmin at 48 hours, 96 hours, and on day eight were 23.4 mg/L, 21.4 mg/L, and 27.8 mg/L, respectively. The patients achieving Cmin ≥ 20 mg/L at 48 hours had a higher likelihood of treatment success. The areas under the receiver operating characteristic curves were 0.71 for clinical efficacy and the cut-off value of Cmin at 48 hours was 18.85 mg/L (95% confidence interval; 0.55–0.87; P = 0.018). Conclusions The Cmin of teicoplanin after completion of loading doses could predict the treatment response, with a target concentration ≥ 18.85 mg/L.