Formulary
Teicoplanin: Indications, Dosing, Side Effects and Interactions
The glycopeptide antibiotic teicoplanin has bactericidal activity against aerobic and anaerobic Gram-positive bacteria including multi-resistant staphylococci.
MedNext Academy | 5 min read
Teicoplanin: Indications, Dosing, Side Effects and Interactions
The glycopeptide antibiotic teicoplanin has bactericidal activity against aerobic and anaerobic Gram-positive bacteria including multi-resistant staphylococci.
Drug action
The glycopeptide antibiotic teicoplanin has bactericidal activity against aerobic and anaerobic Gram-positive bacteria including multi-resistant staphylococci. However, there are reports of Staphylococcus aureus with reduced susceptibility to glycopeptides and increasing reports of glycopeptide-resistant enterococci. Teicoplanin is similar to vancomycin, but has a significantly longer duration of action, allowing once daily administration after the loading dose.
Indications and dose
**Clostridioides difficileinfection**
- **Adult** (By Mouth): Clostridioides difficile infection 100-200 mg twice daily for 7-14 days.
**Moderate diabetic foot infection,Severe diabetic foot infection,Leg ulcer infection**
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): Initially 6 mg/kg every 12 hours for 3 doses, then 6 mg/kg once daily.
**Cellulitis,Erysipelas**
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): Initially 6 mg/kg every 12 hours for 3 doses, then 6 mg/kg once daily.
**Serious infections caused by Gram-positive bacteria (e.g. complicated skin and soft-tissue infections, pneumonia, complicated urinary tract infections)**
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion, Or By Intramuscular Injection): Initially 6 mg/kg every 12 hours for 3 doses, then 6 mg/kg once daily.
**Surgical prophylaxis**
- **Adult** (By Intravenous Injection): 400 mg for 1 dose, to be administered up to 30 minutes before the procedure.
**Surgical prophylaxis in open fractures**
- **Adult** (By Intravenous Infusion): 800 mg for 1 dose, to be administered up to 30 minutes before skeletal stabilisation and definitive soft-tissue closure.
**Clostridioides difficile infection for teicoplanin**
- **Child 12-17 years** (By mouth): 100-200 mg twice daily for 7-14 days.
**Cellulitis, Erysipelas for teicoplanin**
- **Child 1 month** (By intravenous infusion): Initially 16 mg/kg for 1 dose, followed by 8 mg/kg once daily, subsequent dose to be administered 24 hours after initial dose.
- **Child 2 months-11 years** (By intravenous injection, or by intravenous infusion): Initially 10 mg/kg every 12 hours for 3 doses, then 6-10 mg/kg once daily.
- **Child 12-17 years** (By intravenous injection, or by intravenous infusion): Initially 6 mg/kg every 12 hours for 3 doses, then 6 mg/kg once daily.
**Serious infections caused by Gram-positive bacteria (e.g. complicated skin and soft-tissue infections, pneumonia, complicated urinary tract infections) for teicoplanin**
- **Child 12-17 years** (By intravenous injection, or by intravenous infusion, or by intramuscular injection): Initially 6 mg/kg every 12 hours for 3 doses, then 6 mg/kg once daily.
**Streptococcal or enterococcal endocarditis (in combination with another antibacterial), Bone and joint infections for teicoplanin**
- **Child 12-17 years** (Initially by intravenous injection, or by intravenous infusion): 12 mg/kg every 12 hours for 3-5 doses, then (by intravenous injection or by intravenous infusion or by intramuscular injection) 12 mg/kg once daily.
**Surgical prophylaxis for teicoplanin**
- **Child** (By intravenous injection): (consult local protocol).
**Serious infections caused by Gram-positive bacteria (including endocarditis, complicated skin and soft-tissue infections, pneumonia, complicated urinary tract infections, bone and joint infections) for teicoplanin**
- **Neonate** (By intravenous infusion): Initially 16 mg/kg for 1 dose, followed by 8 mg/kg once daily, subsequent dose to be administered 24 hours after initial dose.
- **Child 1 month** (By intravenous infusion): Initially 16 mg/kg for 1 dose, followed by 8 mg/kg once daily, subsequent dose to be administered 24 hours after initial dose.
- **Child 2 months-11 years** (By intravenous injection, or by intravenous infusion): Initially 10 mg/kg every 12 hours for 3 doses, then 6-10 mg/kg once daily.
**Peritonitis associated with peritoneal dialysis (added to dialysis fluid) for teicoplanin**
- **Child 12-17 years** (By intraperitoneal infusion): (consult local protocol).
Side effects
General side-effects: Common or very common Fever; pain; skin reactions Uncommon Bronchospasm; diarrhoea; dizziness; eosinophilia; headache; hearing impairment; hypersensitivity; leucopenia; nausea; ototoxicity; thrombocytopenia; vomiting Rare or very rare Abscess Frequency not known Agranulocytosis; angioedema; chills; increased risk of infection; nephrotoxicity; neutropenia; pancytopenia; renal impairment; seizure; severe cutaneous adverse reactions (SCARs); thrombophlebitis Specific side-effects: Rare or very rare With parenteral use Vancomycin-like infusion reaction Side-effects, further information Teicoplanin is associated with a lower incidence of nephrotoxicity than vancomycin.
Interactions
**Other interactions (4):**
- Teicoplanin should be used with care in conjunction with or sequentially with other medicinal products with known nephrotoxic and/or neurotoxic/ototoxic potential.
- These include e.g.aminoglycosides, colistin, amphotericin B, ciclosporin, cisplatin, furosemide, and ethacrynic acid (see section 4.4 "Nephrotoxicity" and "Ototoxicity").
- However, there is no evidence of synergistic toxicity in combinations with teicoplanin.
- In clinical studies, teicoplanin has been administered to many patients already receiving various medications including other antibiotics, antihypertensives, anaesthetic agents, cardiac medicinal...
Pregnancy
Manufacturer advises use only if potential benefit outweighs risk.
Breast feeding
Specialist sources indicate probably compatible (limited information available). High plasma-protein binding suggests limited excretion into milk and poor oral bioavailability suggests limited absorption by the infant.
Renal impairment
Monitor auditory and renal function regularly during treatment (increased risk of ototoxicity and nephrotoxicity). M Dose adjustments See Prescribing in renal impairment . With intramuscular use or intravenous use: Use normal dose regimen on days 1-4, then if creatinine clearance is: M 30-80 mL/minute, use half the normal maintenance dose (either give the normal maintenance dose every 2 days, or half the normal maintenance dose once daily); less than 30 mL/minute, use one-third of the normal maintenance dose (either give the normal maintenance dose every 3 days, or one-third of the normal maintenance dose once daily). For target serum-teicoplanin trough concentrations-consult product literature or local guidelines.
Medicinal forms
Solution,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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