Therapeutic Drug Monitoring and Nephrotoxicity of Teicoplanin Therapy in Chinese Children: A Retrospective Study

Abstract

Purpose

This study aims to 1) describe the distribution characteristics of teicoplanin trough concentration (C_min) and explore the related influencing factors and 2) evaluate the nephrotoxicity of teicoplanin in children.

Patients and Methods

A cohort of children who were treated with teicoplanin intravenously were included in this retrospective study. Regression analysis was performed to explore the factors associated with the fluctuations of teicoplanin C_min and the development of nephrotoxicity. Classification and regression tree analysis was used to identify the population at high risk for teicoplanin nephrotoxicity.

Results

A total of 269 plasma samples from 186 children were collected. Underexposure (C_min < 10 mg/L) was documented in 52.7% of cases. The C_min/dose after administering the loading dose was strongly associated with age (P = 0.008), weight (P = 0.039), and serum creatinine (P = 0.022). The C_min/dose after administering the maintenance dose was strongly associated with gender (P = 0.014) and serum creatinine (P = 0.006). C_min (P = 0.012) and the concomitant treatment with amphotericin B (P = 0.001) were the independent risk factors for teicoplanin-related nephrotoxicity. Children who were concomitantly treated by amphotericin B with teicoplanin C_min > 9.81 mg/L or patients with teicoplanin C_min > 21.94 mg/L were at high risk for nephrotoxicity.

Conclusion

The fluctuations of teicoplanin C_min could be affected by age, weight, gender, and serum creatinine. C_min and concomitant treatment with amphotericin B were the independent risk factors for nephrotoxicity. We suggested that the therapeutic drug monitoring of teicoplanin should be performed in children.

Keywords:

• teicoplanin
• trough concentration
• children
• nephrotoxicity
• factor

Ethics Approval and Informed Consent

This study was approved by the Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University and the Ethics Committee of Xi’an Children’s Hospital, respectively. Waiving of informed consent was given due to the retrospective, non-interventional study design. All patient data were collected anonymously. This study was performed in accordance with the Declaration of Helsinki. Patients were ensured about the confidentiality of their information.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dan Sun and Tao Zhang are co-first authors for this study. The authors declare that they have no conflicts of interest.