Serum and tissue levels of teicoplanin during cardiac surgery: the effect of a high dose regimen.

Two prospective trials suggested that teicoplanin was less effective in preventing Gram-positive wound infections after cardiac surgery than a combination of flucloxacillin and an aminoglycoside. The initial dose of 400 mg was associated with a subinhibitory concentration of teicoplanin in fat at the end of operation. In this study, the behaviour of a higher initial dose (12 mg/kg) was investigated in ten patients during coronary artery surgery. As in the earlier trials, a second dose (400 mg) was given after 24 h. The mean concentration at the end of cardiopulmonary bypass was 15 mg/l in serum, 6 mg/kg in fat and 9 mg/kg in skin, all in excess of the expected break-point for staphylococci (4 mg/l). The higher dose regimen might be more successful in surgical prophylaxis.