Multicentre evaluation of teicoplanin prescribing and monitoring in the UK and Ireland: the TUcK–SHOP study

Background: Teicoplanin exhibits complex pharmacokinetics with substantial inter-patient variability. Therapeutic drug monitoring (TDM) is recommended to ensure adequate exposure, yet contemporary data on real-world prescribing practices are scarce. We evaluated current teicoplanin dosing and monitoring practices across UK and Irish hospitals. Methods: We conducted a multicentre, retrospective cohort study (Teicoplanin in UK: Study of Hospital Practice; TUcK-SHOP) across 21 hospitals. Adults receiving ≥5 days of intravenous/intramuscular teicoplanin with at least one TDM sample were included. Primary outcome was adherence to local or national dosing guidelines. Secondary outcomes included initial trough level attainment (≥20 mg/L) and laboratory-confirmed toxicity. Multivariable linear regression identified predictors of first trough concentrations. Results: A total of 391 patients met inclusion criteria (median age 69 years; 57.5% male). Guideline adherence was 66% overall but varied widely between sites (5%-100%). Most patients received three-dose loading (61.3%) with median maintenance dosing of 10.6 mg/kg daily (IQR 7.3-12.1). Median first trough level was 24.6 mg/L (IQR 17.9-33.2); only 40.8% of patients on 6 mg/kg maintenance achieved ≥20 mg/L versus 86.6% on 12 mg/kg (P < 0.001). Independent predictors of higher trough levels included lower creatinine clearance, longer time to TDM sampling, higher loading and maintenance doses, and greater body weight (adjusted R2 = 0.26, P < 0.001). Dose adjustments were required in 30% of patients. Conclusions: Teicoplanin prescribing demonstrates significant variation across UK and Irish hospitals. Higher maintenance dosing (10-12 mg/kg) predicts therapeutic target attainment. These real-world data support the need for standardized dosing protocols to optimize teicoplanin therapy.

Citation

Hughes, S., Cheong, J., Snape, J., Jethwa, S., Ng, S. H., Thangarajah, R., Escayo, T., Mcintyre, B., Chong, S. W., Stone, A., Oakley, R., Frost, K., Watson, C., Brandish, C., Martin, D., Lewis, N., Liu, A., Patel, R., Ahmad, D., Patel, A., … Hamilton, R. (2026). Multicentre evaluation of teicoplanin prescribing and monitoring in the UK and Ireland: the TUcK-SHOP study. The Journal of antimicrobial chemotherapy, 81(3), dkag038. https://doi.org/10.1093/jac/dkag038

DOI

10.1093/jac/dkag038

URI

https://hdl.handle.net/20.500.14709/1300