Comparision of plasma concentrations of different load regimes of teicoplanin in patients with osteomyelitis by liquid chromatography-mass spectrometry monitoring

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Author: Hui-Min YU ¹ Hui-Jie YUE ¹ Hong-Bo QIAN ¹ Yan-Jie ZHANG ² Zhi-Wei HE ²  Qing ZHOU ¹

Affiliation: 1. Department of Clinical Pharmacy, General Hospital of Eastern Theater Command of the PLA, Nanjing 210002, China 2. Department of Orthopedics, General Hospital of Eastern Theater Command of the PLA, Nanjing 210002, China

Keywords: Teicoplanin Loading regimen Trough concentration Therapeutic drug monitoring LC-MS/MS

DOI: 10.12173/j.issn.1008-049X.202209161

Reference: Hui-Min YU, Hui-Jie YUE, Hong-Bo QIAN, Yan-Jie ZHANG, Zhi-Wei HE, Qing ZHOU.Comparision of plasma concentrations of different load regimes of teicoplanin in patients with osteomyelitis by liquid chromatography-mass spectrometry monitoring[J].Zhongguo Yaoshi Zazhi,2023, 26(10):51-58.DOI: 10.12173/j.issn.1008-049X.202209161.[Article in Chinese]  Copied

Abstract
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Abstract

Objective To establish and validate a liquid chromatography-mass spectrometry (LC-MS/MS) method for the detection of teicoplanin concentration in plasma, and to analyze the achievement of teicoplanin trough concentrations (C_min) in patients with osteomyelitis at different loading doses in General Hospital of Eastern Theater Command of the PLA.

Methods To establish an LC-MS/MS method for the determination of teicoplanin C_min and investigate the specificity, standard curve, precision and recovery, matrix effect and stability of the method. 43 patients with osteomyelitis treated with teicoplanin were divided into two groups according to the dosing regimen: test group A received three loading doses of 400 mg, q12h and test group B received six loading doses of 400 mg, q12h, along with multiple therapeutic drug monitoring (TDM). In both groups, samples were collected 30 min before the maintenance dose on day four to detect teicoplanin C_min values in patients and teicoplanin C_min targets were compared between two groups.

Results The standard curve equation of teicoplanin in plasma was Y=0.032 4X+0.000 886 (r=0.996 4), and the linear relationship was good within 0.20-50.00 μg·mL^-1; the accuracy of quality control samples was 94.71%-112.50%; the intra-day and inter-day RSDs were 3.17%-15.19%; the extraction recoveries were 81.22%-91.26%; and the matrix effect was 93.54%-119.78%. In clinical application, the mean C_min of teicoplanin after loading dose in test group A was (8.32±4.76) μg·mL^-1, and the proportion of C_min≥10 μg·mL^-1 was only 25.90%; the mean C_min of teicoplanin after loading dose in test group B was (19.58±7.78) μg·mL^-1, and C_min was≥10 μg·mL^-1 in all 16 patients. There was a significant difference in mean C_min between two groups (P<0.000 1).

Conclusion The LC-MS/MS method developed in this trial is suitable for routine TDM with teicoplanin. In clinical practice, teicoplanin C_min compliance was poor with low-frequency loading regimens, while teicoplanin C_min compliance was superior with TDM-guided high-frequency loading regimens. Studies have shown the importance of teicoplanin TDM, particularly in patients at high risk of infection.

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