Optimal trough concentration of teicoplanin for the treatment of methicillin‐resistant Staphylococcus aureus infection: A systematic review and meta‐analysis
What is known and objective It has been recommended that the trough concentration (Cmin) of teicoplanin should be maintained at ≥20 μg/ml for difficult‐to‐treat complicated infections caused by methicillin‐resistant Staphylococcus aureus (MRSA). Conversely, Cmin of teicoplanin of at least 10 μg/ml i...
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| Veröffentlicht in: | Journal of clinical pharmacy and therapeutics 2021-06, Vol.46 (3), p.622-632 |
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| container_title | Journal of clinical pharmacy and therapeutics |
| container_volume | 46 |
| creator | Hanai, Yuki Takahashi, Yoshiko Niwa, Takashi Mayumi, Toshihiko Hamada, Yukihiro Kimura, Toshimi Matsumoto, Kazuaki Fujii, Satoshi Takesue, Yoshio |
| description | What is known and objective
It has been recommended that the trough concentration (Cmin) of teicoplanin should be maintained at ≥20 μg/ml for difficult‐to‐treat complicated infections caused by methicillin‐resistant Staphylococcus aureus (MRSA). Conversely, Cmin of teicoplanin of at least 10 μg/ml is required for non‐complicated MRSA infections. Considering the low incidence of nephrotoxicity for teicoplanin, Cmin = 15–30 μg/ml has been suggested for most MRSA infections. Thus, we assessed the clinical efficacy and adverse effects of teicoplanin at this target Cmin.
Methods
We searched electronic databases (PubMed, Cochrane Central Register of Controlled Trials and Ichushi‐Web) to identify eligible studies. Studies were included if they provided the incidence of treatment success, mortality in patients with MRSA infection, and/or hepatotoxicity and nephrotoxicity according to the Cmin range.
Results and discussion
Four trials assessing clinical success (n = 299) and three studies assessing adverse effects (n = 546) were included. Cmin = 15–30 μg/ml significantly increased the probability of treatment success compared with Cmin |
| doi_str_mv | 10.1111/jcpt.13366 |
| format | Article |
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It has been recommended that the trough concentration (Cmin) of teicoplanin should be maintained at ≥20 μg/ml for difficult‐to‐treat complicated infections caused by methicillin‐resistant Staphylococcus aureus (MRSA). Conversely, Cmin of teicoplanin of at least 10 μg/ml is required for non‐complicated MRSA infections. Considering the low incidence of nephrotoxicity for teicoplanin, Cmin = 15–30 μg/ml has been suggested for most MRSA infections. Thus, we assessed the clinical efficacy and adverse effects of teicoplanin at this target Cmin.
Methods
We searched electronic databases (PubMed, Cochrane Central Register of Controlled Trials and Ichushi‐Web) to identify eligible studies. Studies were included if they provided the incidence of treatment success, mortality in patients with MRSA infection, and/or hepatotoxicity and nephrotoxicity according to the Cmin range.
Results and discussion
Four trials assessing clinical success (n = 299) and three studies assessing adverse effects (n = 546) were included. Cmin = 15–30 μg/ml significantly increased the probability of treatment success compared with Cmin < 15 μg/ml (odds ratio [OR] = 2.68, 95% confidence interval [CI] = 1.14–6.32, p = 0.02). The all‐cause mortality rate did not differ between the groups (OR = 0.46, 95% CI = 0.13–1.61, p = 0.22). Cmin = 15–30 μg/ml did not increase the risks of nephrotoxicity (OR = 0.91, 95% CI = 0.49–1.69, p = 0.76) or hepatotoxicity (OR = 0.67, 95% CI = 0.18–2.44, p = 0.54).
What is new and conclusion
Teicoplanin therapy using a Cmin target of 15–30 μg/ml is likely to be associated with better clinical responses than Cmin < 15 μg/ml without increasing the risk of adverse effects.</description><identifier>ISSN: 0269-4727</identifier><identifier>EISSN: 1365-2710</identifier><identifier>DOI: 10.1111/jcpt.13366</identifier><identifier>PMID: 33547647</identifier><language>eng</language><publisher>England: Hindawi Limited</publisher><subject>Clinical trials ; Drug resistance ; gram‐positive bacteria ; Hepatotoxicity ; Meta-analysis ; Methicillin ; methicillin‐resistant Staphylococcus aureus ; Mortality ; Side effects ; Staphylococcus aureus ; Staphylococcus infections ; Success ; Teicoplanin ; therapeutic drug monitoring ; trough concentration</subject><ispartof>Journal of clinical pharmacy and therapeutics, 2021-06, Vol.46 (3), p.622-632</ispartof><rights>2021 John Wiley & Sons Ltd</rights><rights>2021 John Wiley & Sons Ltd.</rights><rights>Copyright © 2021 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3936-3947a3d203b353963f2199cffbfd9a49a6f1cb06b17e1401fbb357f4aaf9c0df3</citedby><cites>FETCH-LOGICAL-c3936-3947a3d203b353963f2199cffbfd9a49a6f1cb06b17e1401fbb357f4aaf9c0df3</cites><orcidid>0000-0002-4606-7150 ; 0000-0001-6990-425X ; 0000-0001-8671-5856</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjcpt.13366$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjcpt.13366$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33547647$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hanai, Yuki</creatorcontrib><creatorcontrib>Takahashi, Yoshiko</creatorcontrib><creatorcontrib>Niwa, Takashi</creatorcontrib><creatorcontrib>Mayumi, Toshihiko</creatorcontrib><creatorcontrib>Hamada, Yukihiro</creatorcontrib><creatorcontrib>Kimura, Toshimi</creatorcontrib><creatorcontrib>Matsumoto, Kazuaki</creatorcontrib><creatorcontrib>Fujii, Satoshi</creatorcontrib><creatorcontrib>Takesue, Yoshio</creatorcontrib><title>Optimal trough concentration of teicoplanin for the treatment of methicillin‐resistant Staphylococcus aureus infection: A systematic review and meta‐analysis</title><title>Journal of clinical pharmacy and therapeutics</title><addtitle>J Clin Pharm Ther</addtitle><description>What is known and objective
It has been recommended that the trough concentration (Cmin) of teicoplanin should be maintained at ≥20 μg/ml for difficult‐to‐treat complicated infections caused by methicillin‐resistant Staphylococcus aureus (MRSA). Conversely, Cmin of teicoplanin of at least 10 μg/ml is required for non‐complicated MRSA infections. Considering the low incidence of nephrotoxicity for teicoplanin, Cmin = 15–30 μg/ml has been suggested for most MRSA infections. Thus, we assessed the clinical efficacy and adverse effects of teicoplanin at this target Cmin.
Methods
We searched electronic databases (PubMed, Cochrane Central Register of Controlled Trials and Ichushi‐Web) to identify eligible studies. Studies were included if they provided the incidence of treatment success, mortality in patients with MRSA infection, and/or hepatotoxicity and nephrotoxicity according to the Cmin range.
Results and discussion
Four trials assessing clinical success (n = 299) and three studies assessing adverse effects (n = 546) were included. Cmin = 15–30 μg/ml significantly increased the probability of treatment success compared with Cmin < 15 μg/ml (odds ratio [OR] = 2.68, 95% confidence interval [CI] = 1.14–6.32, p = 0.02). The all‐cause mortality rate did not differ between the groups (OR = 0.46, 95% CI = 0.13–1.61, p = 0.22). Cmin = 15–30 μg/ml did not increase the risks of nephrotoxicity (OR = 0.91, 95% CI = 0.49–1.69, p = 0.76) or hepatotoxicity (OR = 0.67, 95% CI = 0.18–2.44, p = 0.54).
What is new and conclusion
Teicoplanin therapy using a Cmin target of 15–30 μg/ml is likely to be associated with better clinical responses than Cmin < 15 μg/ml without increasing the risk of adverse effects.</description><subject>Clinical trials</subject><subject>Drug resistance</subject><subject>gram‐positive bacteria</subject><subject>Hepatotoxicity</subject><subject>Meta-analysis</subject><subject>Methicillin</subject><subject>methicillin‐resistant Staphylococcus aureus</subject><subject>Mortality</subject><subject>Side effects</subject><subject>Staphylococcus aureus</subject><subject>Staphylococcus infections</subject><subject>Success</subject><subject>Teicoplanin</subject><subject>therapeutic drug monitoring</subject><subject>trough concentration</subject><issn>0269-4727</issn><issn>1365-2710</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc9u1DAQhy0EotvChQdAlrghpbUzWVvmVq34U1SpSJRz5Dhj1qvEDrZDlRuPwCvwajxJHbZwZC5zmE_fjOZHyAvOznmpi4OZ8jkHEOIR2XAQ26qWnD0mG1YLVTWylifkNKUDY0zIGp6SE4BtI0UjN-TXzZTdqAeaY5i_7qkJ3qDPUWcXPA2WZnQmTIP2zlMbIs17LCzqPBZsBUbMe2fcMDj_-8fPiMmlrMvoc9bTfhmCCcbMieo5YmnOWzSr-w29pGlJGceyytCI3x3eUe37VaiLSXs9LEX2jDyxekj4_KGfkS_v3t7uPlTXN--vdpfXlQEFogLVSA19zaCDLSgBtuZKGWs72yvdKC0sNx0THZfIG8ZtVzhpG62tMqy3cEZeHb1TDN9mTLk9hDmWI1JbbwEYVzVAoV4fKRNDShFtO8Xyv7i0nLVrGu2aRvsnjQK_fFDO3Yj9P_Tv-wvAj8CdG3D5j6r9uPt0e5TeA-mZnBA</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Hanai, Yuki</creator><creator>Takahashi, Yoshiko</creator><creator>Niwa, Takashi</creator><creator>Mayumi, Toshihiko</creator><creator>Hamada, Yukihiro</creator><creator>Kimura, Toshimi</creator><creator>Matsumoto, Kazuaki</creator><creator>Fujii, Satoshi</creator><creator>Takesue, Yoshio</creator><general>Hindawi Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><orcidid>https://orcid.org/0000-0002-4606-7150</orcidid><orcidid>https://orcid.org/0000-0001-6990-425X</orcidid><orcidid>https://orcid.org/0000-0001-8671-5856</orcidid></search><sort><creationdate>202106</creationdate><title>Optimal trough concentration of teicoplanin for the treatment of methicillin‐resistant Staphylococcus aureus infection: A systematic review and meta‐analysis</title><author>Hanai, Yuki ; Takahashi, Yoshiko ; Niwa, Takashi ; Mayumi, Toshihiko ; Hamada, Yukihiro ; Kimura, Toshimi ; Matsumoto, Kazuaki ; Fujii, Satoshi ; Takesue, Yoshio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3936-3947a3d203b353963f2199cffbfd9a49a6f1cb06b17e1401fbb357f4aaf9c0df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Clinical trials</topic><topic>Drug resistance</topic><topic>gram‐positive bacteria</topic><topic>Hepatotoxicity</topic><topic>Meta-analysis</topic><topic>Methicillin</topic><topic>methicillin‐resistant Staphylococcus aureus</topic><topic>Mortality</topic><topic>Side effects</topic><topic>Staphylococcus aureus</topic><topic>Staphylococcus infections</topic><topic>Success</topic><topic>Teicoplanin</topic><topic>therapeutic drug monitoring</topic><topic>trough concentration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hanai, Yuki</creatorcontrib><creatorcontrib>Takahashi, Yoshiko</creatorcontrib><creatorcontrib>Niwa, Takashi</creatorcontrib><creatorcontrib>Mayumi, Toshihiko</creatorcontrib><creatorcontrib>Hamada, Yukihiro</creatorcontrib><creatorcontrib>Kimura, Toshimi</creatorcontrib><creatorcontrib>Matsumoto, Kazuaki</creatorcontrib><creatorcontrib>Fujii, Satoshi</creatorcontrib><creatorcontrib>Takesue, Yoshio</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><jtitle>Journal of clinical pharmacy and therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hanai, Yuki</au><au>Takahashi, Yoshiko</au><au>Niwa, Takashi</au><au>Mayumi, Toshihiko</au><au>Hamada, Yukihiro</au><au>Kimura, Toshimi</au><au>Matsumoto, Kazuaki</au><au>Fujii, Satoshi</au><au>Takesue, Yoshio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimal trough concentration of teicoplanin for the treatment of methicillin‐resistant Staphylococcus aureus infection: A systematic review and meta‐analysis</atitle><jtitle>Journal of clinical pharmacy and therapeutics</jtitle><addtitle>J Clin Pharm Ther</addtitle><date>2021-06</date><risdate>2021</risdate><volume>46</volume><issue>3</issue><spage>622</spage><epage>632</epage><pages>622-632</pages><issn>0269-4727</issn><eissn>1365-2710</eissn><abstract>What is known and objective
It has been recommended that the trough concentration (Cmin) of teicoplanin should be maintained at ≥20 μg/ml for difficult‐to‐treat complicated infections caused by methicillin‐resistant Staphylococcus aureus (MRSA). Conversely, Cmin of teicoplanin of at least 10 μg/ml is required for non‐complicated MRSA infections. Considering the low incidence of nephrotoxicity for teicoplanin, Cmin = 15–30 μg/ml has been suggested for most MRSA infections. Thus, we assessed the clinical efficacy and adverse effects of teicoplanin at this target Cmin.
Methods
We searched electronic databases (PubMed, Cochrane Central Register of Controlled Trials and Ichushi‐Web) to identify eligible studies. Studies were included if they provided the incidence of treatment success, mortality in patients with MRSA infection, and/or hepatotoxicity and nephrotoxicity according to the Cmin range.
Results and discussion
Four trials assessing clinical success (n = 299) and three studies assessing adverse effects (n = 546) were included. Cmin = 15–30 μg/ml significantly increased the probability of treatment success compared with Cmin < 15 μg/ml (odds ratio [OR] = 2.68, 95% confidence interval [CI] = 1.14–6.32, p = 0.02). The all‐cause mortality rate did not differ between the groups (OR = 0.46, 95% CI = 0.13–1.61, p = 0.22). Cmin = 15–30 μg/ml did not increase the risks of nephrotoxicity (OR = 0.91, 95% CI = 0.49–1.69, p = 0.76) or hepatotoxicity (OR = 0.67, 95% CI = 0.18–2.44, p = 0.54).
What is new and conclusion
Teicoplanin therapy using a Cmin target of 15–30 μg/ml is likely to be associated with better clinical responses than Cmin < 15 μg/ml without increasing the risk of adverse effects.</abstract><cop>England</cop><pub>Hindawi Limited</pub><pmid>33547647</pmid><doi>10.1111/jcpt.13366</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-4606-7150</orcidid><orcidid>https://orcid.org/0000-0001-6990-425X</orcidid><orcidid>https://orcid.org/0000-0001-8671-5856</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of clinical pharmacy and therapeutics, 2021-06, Vol.46 (3), p.622-632 |
| issn | 0269-4727 1365-2710 |
| language | eng |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Clinical trials Drug resistance gram‐positive bacteria Hepatotoxicity Meta-analysis Methicillin methicillin‐resistant Staphylococcus aureus Mortality Side effects Staphylococcus aureus Staphylococcus infections Success Teicoplanin therapeutic drug monitoring trough concentration |
| title | Optimal trough concentration of teicoplanin for the treatment of methicillin‐resistant Staphylococcus aureus infection: A systematic review and meta‐analysis |
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