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

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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.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank all the participants of the study.

Funding

This work and the journal’s Rapid Service and Open Access fees was supported by National Taiwan University Hospital [grant numbers 108-S4335].

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Authors and Affiliations

  1. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan

    Yu-Wen Wang, Hsing-Yu Lin & Pin-Zi Chen

  2. School of Pharmacy, College of Medicine, National Taiwan University, 33, Linsen S. Rd, Room 216, Taipei, Taiwan

    Yu-Wen Wang, Ching-Hua Kuo, Huai-Hsuan Chiu, Chia-Chi Chuang & Shu-Wen Lin

  3. Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Hsin-An Hou & Chien-Chin Lin

  4. Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Chien-Chin Lin

  5. Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan

    Huai-Hsuan Chiu & Chia-Chi Chuang

  6. Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan

    Yi-**g Chen & Shu-Wen Lin

  7. National Taiwan University Cancer Center, Taipei, Taiwan

    Shu-Wen Lin

Authors
  1. Yu-Wen Wang
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Contributions

Yu-Wen Wang drafted the manuscript; Yu-Wen Wang, Hsin-An Hou, Chien-Chin Lin and Shu-Wen Lin designed the research; Yu-Wen Wang, Hsing-Yu Lin and Pin-Zi Chen performed the research; Yu-Wen Wang and Shu-Wen Lin analyzed the data and completed statistical analysis; Ching-Hua Kuo, Huai-Hsuan Chiu, Chia-Chi Chuang and Yi-**g Chen contributed to development and conduction of analytical tools.

Corresponding author

Correspondence to Shu-Wen Lin.

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Conflict of Interest

All the authors, Yu-Wen Wang, Hsin-An Hou, Chien-Chin Lin, Hsing-Yu Lin, Pin-Zi Chen, Ching-Hua Kuo, Huai-Hsuan Chiu, Chia-Chi Chuang, Yi-**g Chen, Shu-Wen Lin confirm that they have no conflicts of interest to disclose.

Ethical Approval

Ethical approval was obtained from the NTUH Research Ethics Committee (registration no. 201807132RINA) in accordance with the Declaration of Helsinki.

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Wang, YW., Hou, HA., Lin, CC. et al. Early Therapeutic Drug Monitoring Optimizes Teicoplanin Use in Febrile Neutropenic Patients with Hematological Malignancies. Adv Ther 41, 2966–2977 (2024). https://doi.org/10.1007/s12325-024-02884-z

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  • DOI: https://doi.org/10.1007/s12325-024-02884-z

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