Individualized Dosing Regimens of Teicoplanin for Patients with Hypoalbuminemia Based on Population Pharmacokinetics and Pharmacokinetic/Pharmacodynamic Parameters

Introduction Teicoplanin is widely used for the treatment of Gram-positive bacterial infections. Although its pharmacokinetics are influenced by serum albumin, population pharmacokinetic models and individualized dosing regimens specifically for patients with hypoalbuminemia have not been established. Inadequate drug exposure risks prolonged treatment duration or therapeutic failure, underscoring the critical importance of dose optimization. Aim The aim of this study was to characterize the pharmacokinetics of teicoplanin in patients with hypoalbuminemia, determine pharmacokinetic/pharmacodynamic targets, and develop individualized dosing regimens for clinical application. Method A retrospective study was conducted in a cohort of 195 Chinese adult patients with hypoalbuminemia, and a population pharmacokinetic model was developed using their clinical data. Classification and regression tree analysis combined with survival analysis was used to identify pharmacokinetic/pharmacodynamic parameter breakpoints. Monte Carlo simulation was employed to develop individualized dosing regimens. Results In the final model, the population typical value for clearance was 0.612 L/h, with estimated glomerular filtration rate (eGFR) as a covariate, and the value for apparent volume of distribution was 91.2 L, with albumin and urea as its covariates. C _min ≥ 15 mg/L and AUC ₂₄ /MIC ≥ 790 were identified as pharmacokinetic/pharmacodynamic parameter breakpoints. Several individualized dosing regimens were developed based on albumin, eGFR and urea of patients and MIC of bacteria. Conclusion For patients with hypoalbuminemia, albumin, eGFR, urea, and MIC are important considerations for individualized dosing regimens of teicoplanin to achieve pharmacokinetic/pharmacodynamic targets, thereby improving clinical efficacy.