teicoplanin

Teicoplanin is a glycopeptide antibiotic produced by the actinomycete Actinoplanes teichomyceticus. It inhibits bacterial cell wall synthesis by binding to the D-alanyl-D-alanyl terminus of peptidoglycan precursors, a mechanism analogous to vancomycin. Teicoplanin is used for serious Gram-positive infections and is an alternative when vancomycin is not suitable.

The antibiotic has activity primarily against Gram-positive cocci, including methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE), and streptococci. It has limited activity against enterococci and no activity against most Gram-negative bacteria. Teicoplanin is typically reserved for infections caused by susceptible Gram-positive organisms, such as bacteremia, endocarditis, osteomyelitis, or pneumonia, when broader agents are inappropriate or when vancomycin is contraindicated or poorly tolerated.

Pharmacokinetically, teicoplanin is characterized by a relatively long half-life, allowing once-daily dosing after an initial loading phase. It is usually administered intravenously or intramuscularly. Clearance is largely renal, and dose adjustments are necessary in renal impairment. Serum trough level monitoring may be used to optimize therapy and minimize toxicity.

Adverse effects are generally fewer than with vancomycin but can include nephrotoxicity and ototoxicity, infusion-related reactions, phlebitis at the injection site, hypersensitivity, and rare hepatic abnormalities. Drug interactions with other nephrotoxic agents can increase the risk of kidney injury.

In terms of resistance, decreased susceptibility can occur via alterations of the target site, and cross-resistance with vancomycin is possible in some strains carrying resistance determinants such as vanA. Teicoplanin is marketed in Europe and several other regions (often under brand names like Targocid) but is not approved by the U.S. FDA.