Early Therapeutic Drug Monitoring Optimizes Teicoplanin Use in Febrile Neutropenic Patients with Hematological Malignancies.
Journal
Advances in therapy
Journal Volume
41
Journal Issue
7
Pages
2966 - 2977
ISSN
1865-8652
Date Issued
2024-07
Author(s)
Wang, Yu-Wen
Hou, Hsin-An
Lin, Hsing-Yu
Chen, Pin-Zi
Kuo, Ching-Hua
Chiu, Huai-Hsuan
Chuang, Chia-Chi
Chen, Yi-Jing
Lin, Shu-Wen
Abstract
Introduction: A target trough concentration (Cmin) of teicoplanin ≥ 15–20 mg/L between the fourth and sixth day has been suggested for severe infections or 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 patients with hematological malignancies who were treated with teicoplanin either as an empirical antibiotic for FN or as targeted treatment for Gram-positive bacteria. Blood samples were collected on day three (48 h) post-loading doses, day 5 (96 h), and day 8 (when applicable) and determined by ultrahigh-pressure liquid chromatography–triple quadruple mass spectrometry. A total of 117 samples from 47 patients with FN (27 men, 20 women) were consecutively analyzed. A two-tailed α value of 0.05 was considered statistically significant. Results: The mean Cmin values at 48 h, 96 h, and on day 8 were 23.4, 21.4, and 27.8 mg/L, respectively. The patients achieving Cmin ≥ 20 mg/L at 48 h had a higher likelihood of treatment success. The areas under the receiver operating characteristic curves were 0.71 for clinical efficacy and the cutoff value of Cmin at 48 h 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.
Subjects
Febrile neutropenia
Hematological malignancies
Teicoplanin
Therapeutic drug monitoring
SDGs
Publisher
Adis
Type
journal article