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

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.