Steady-state trough serum and epithelial lining fluid concentrations of teicoplanin 12 mg/kg per day in patients with ventilator-associated pneumonia

To determine the steady-state trough serum and epithelial lining fluid (ELF) concentrations of teicoplanin 12 mg/kg per day in critically ill patients with ventilator associated pneumonia. Prospective, pharmacokinetic study in the surgical intensive care unit in a university hospital. Thirteen adult patients with nosocomial bacterial pneumonia on mechanical ventilation were enrolled. All subjects received a 30-min intravenous infusion of 12 mg/kg teicoplanin every 12 h for 2 consecutive days followed by 12 mg/kg once daily. Teicoplanin concentrations in serum and ELF were determined simultaneously 4–6 days after antibiotic administration started. The median total and free concentrations of teicoplanin in serum at trough were 15.9 μg/ml (range 8.8–29.9) and 3.7 (2.0–5.4), respectively. The concentration in ELF was 4.9 (2.0–11.8). In critically ill patients with ventilator-associated pneumonia the administration of high teicoplanin doses is required to reach sufficient trough antibiotic concentrations in lung tissues at steady state. At that time trough-free concentrations of teicoplanin in serum and ELF are comparable.