Pharmacokinetics of teicoplanin in paediatric patients—A systematic review of current literature

Background and Objective: Teicoplanin is commonly used in children to treat gram-positive infections and is sometimes used off-label prophylactically in surgical or paediatric oncology settings. The pharmacokinetics (PK) of teicoplanin in children exhibit considerable variability, such as in critically ill children or those with renal impairment. This systematic review aims to summarize and evaluate reported PK data and target attainment, identify PK variations and provide dosing recommendations when available. Methods: A systematic literature search was performed in PubMed and Embase, following PRISMA 2020 guidelines. Included studies were randomized controlled trials, nonrandomized controlled trials or prospective/retrospective cohort studies, published up to December 2024, that assessed PK or teicoplanin exposure in children. Data on PK, target attainment, efficacy, and toxicity were extracted. Results: Twenty-six articles were included in the final analysis, revealing significant PK variability among subgroups (neonates, infants, children aged ≥1 year, children with renal impairment, critically ill children and paediatric oncology patients). This variability is partially explained by covariates such as kidney function, illness and age. In critically ill and paediatric oncology patients, clearance (CL) was higher. Compared with other populations, the volume of distribution (Vd) in critically ill children appeared somewhat higher. A positive correlation between CL and kidney function was identified. Conclusion: Teicoplanin PK in children is highly variable, with target trough levels often not achieved, making universal dosing recommendations challenging. Future studies should define indication-dependent targets. Therapeutic drug monitoring could improve clinical efficacy. Defining unbound exposure and its clinical correlates should be a priority for future research.