Teicoplanin 

1. Introduction

Teicoplanin is a glycopeptide antibiotic used primarily against serious Gram-positive infections, especially when resistance or intolerance to β-lactams exists.

• Give loading dose.
• Do NOT use for Gram-negative sepsis.
• Prefer in:
• High vancomycin MIC
• Vancomycin intolerance
• Long-term therapy (osteomyelitis)

2. Classification

• Bactericidal
• Time-dependent killing
• Concentration-dependent post-antibiotic effect (PAE)

Other glycopeptides:

• Vancomycin
• Telavancin
• Dalbavancin
• Oritavancin

3. Mechanism of Action 

Teicoplanin inhibits cell wall synthesis.

 Molecular Mechanism:

• Prevents:
• Transglycosylation
• Transpeptidation
• Blocks peptidoglycan cross-linking
• Leads to bacterial cell death

4. Antimicrobial Spectrum

 Strong Activity Against:

• MRSA
• MSSA
• Coagulase-negative staphylococci
• Streptococci
• Enterococci (not VRE)
• Clostridium spp.
• Corynebacterium

 No Activity Against:

• Gram-negative bacteria
• Anaerobic Gram-negatives
• Atypicals

⚠ Not effective against VanA-type VRE.

5. Pharmacokinetics 

Clinical Implications:

• Once daily dosing possible
• Requires loading dose
• Dose adjust in renal failure
• Safe in hepatic dysfunction

6. Renal Failure Adjustment

7. Therapeutic Drug Monitoring (TDM)

Not mandatory in mild infections but recommended in:

• Endocarditis
• Osteomyelitis
• Bacteremia
• Renal dysfunction
• Obesity

8. Clinical Indications

• MRSA Bacteremia
• Infective Endocarditis,Often combined with gentamicin
• Catheter-Related Bloodstream Infection
• Bone & Joint Infection
• Skin & Soft Tissue Infection
• Peritonitis (PD-related)

9. Adverse Effects

 Common

• Rash
• Fever
• Injection site pain

 Nephrotoxicity

• Less than vancomycin but possible.
• Ototoxicity-Rare.
• Thrombocytopenia-Occasional.
• Red Man Syndrome?Much rarer than vancomycin.

10. Resistance Mechanisms

1. Altered D-Ala-D-Lac (VanA type)
2. Thickened cell wall (VISA-like phenotype)
3. Reduced penetration