Teicoplanin Bradex
Glycopeptide antibiotic for serious Gram-positive bacterial infections
Teicoplanin Bradex is a glycopeptide antibiotic containing teicoplanin as its active ingredient. It is used in hospital settings to treat serious bacterial infections caused by Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA). Teicoplanin works by inhibiting bacterial cell wall synthesis. It is administered intravenously or intramuscularly, and can also be given orally for Clostridioides difficile infections.
Quick Facts
Key Takeaways
- Teicoplanin Bradex is a hospital-administered glycopeptide antibiotic effective against serious Gram-positive infections, including MRSA.
- Its long half-life (70–100 hours) allows convenient once-daily dosing after initial loading doses.
- It can be given intravenously, intramuscularly, or orally (for C. difficile colitis), offering flexible administration routes.
- Monitoring of kidney function, liver enzymes, blood counts, and hearing is required during prolonged therapy.
- Do not mix teicoplanin with aminoglycosides in the same syringe or infusion line due to incompatibility and additive toxicity risks.
What Is Teicoplanin Bradex and What Is It Used For?
Teicoplanin Bradex belongs to the glycopeptide class of antibiotics, a group of powerful antimicrobial agents primarily used in hospital settings for serious and life-threatening infections. The active substance, teicoplanin, was first isolated from Actinoplanes teichomyceticus and has been used clinically since the 1980s. It works by binding to the D-alanyl-D-alanine terminus of peptidoglycan precursors in the bacterial cell wall, effectively inhibiting the transglycosylation and transpeptidation steps required for cell wall cross-linking. Without a functional cell wall, susceptible bacteria cannot survive and are killed.
Teicoplanin demonstrates bactericidal activity against a broad range of Gram-positive organisms, including methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA), coagulase-negative staphylococci, Streptococcus species (including S. pneumoniae and S. pyogenes), Enterococcus faecalis, Listeria monocytogenes, and Clostridioides difficile. It is not active against Gram-negative bacteria.
The approved clinical indications for Teicoplanin Bradex include treatment of the following infections in adults and children (including neonates):
- Skin and soft tissue infections – including complicated skin infections, cellulitis, wound infections, and surgical site infections caused by susceptible Gram-positive bacteria.
- Bone and joint infections – osteomyelitis and septic arthritis, frequently caused by staphylococci, where prolonged antibiotic courses are often required.
- Pneumonia – hospital-acquired and ventilator-associated pneumonia caused by Gram-positive pathogens.
- Urinary tract infections – complicated urinary infections involving Gram-positive organisms.
- Infective endocarditis – infection of the heart valves, a serious condition requiring intensive and prolonged antibiotic therapy.
- Peritonitis – infection of the abdominal lining, including peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD).
- Bacteremia (bloodstream infection) – when caused by or associated with any of the above conditions.
- Clostridioides difficile infection (CDI) – when given orally as a solution, teicoplanin is effective against C. difficile colitis, a common hospital-acquired infection.
One of the key pharmacological advantages of teicoplanin over its structural relative vancomycin is its significantly longer elimination half-life, approximately 70 to 100 hours in patients with normal renal function. This allows once-daily dosing after an initial series of loading doses, simplifying treatment schedules and facilitating outpatient parenteral antibiotic therapy (OPAT) in appropriate cases. Additionally, teicoplanin can be administered intramuscularly, which is not possible with vancomycin due to local tissue irritation.
Teicoplanin is listed on the WHO Model List of Essential Medicines as a reserve antibiotic for use in serious infections where first-line agents are ineffective. Its use should be guided by antimicrobial susceptibility testing and local antimicrobial stewardship policies.
What Should You Know Before Taking Teicoplanin Bradex?
Contraindications
Teicoplanin Bradex must not be used if you have a known hypersensitivity (allergy) to teicoplanin or any of the other ingredients in the medicine. The excipients include sodium chloride and sodium hydroxide (for pH adjustment), and the diluent is water for injections. If you have previously experienced an allergic reaction to teicoplanin, including symptoms such as rash, itching, swelling, difficulty breathing, or anaphylaxis, you must not receive this medicine again.
Warnings and Precautions
Before receiving Teicoplanin Bradex, inform your doctor, pharmacist, or nurse about any of the following conditions, as they may affect how the medicine is used or require additional monitoring:
- Vancomycin allergy: Patients with known hypersensitivity to vancomycin may have an increased risk of cross-reactivity with teicoplanin. Although the chemical structures differ, both belong to the glycopeptide class. Your physician should exercise caution and may choose to administer teicoplanin under close observation.
- Red man syndrome: This infusion-related reaction, characterised by flushing and erythema of the upper body, is less common with teicoplanin than with vancomycin but has been reported. Slow infusion rates can minimise this risk.
- Thrombocytopenia: A decrease in blood platelet count has been reported with teicoplanin use. Regular monitoring of complete blood counts is recommended, especially during prolonged treatment.
- Kidney impairment: Patients with pre-existing renal impairment require dose adjustments and closer monitoring of renal function. Teicoplanin is primarily eliminated by the kidneys, and accumulation can occur in patients with reduced creatinine clearance.
- Concurrent ototoxic or nephrotoxic medicines: If you are taking other medications that can affect hearing or kidney function, your doctor will monitor you more closely with regular blood tests, renal function assessments, and audiometry if appropriate.
During treatment, your doctor may order regular blood tests to check your kidney function (serum creatinine), liver function (liver enzymes), complete blood count, and hearing. This is especially important if:
- Treatment is expected to continue for a prolonged period (more than 7 days)
- High loading doses are required (12 mg/kg twice daily)
- You have pre-existing kidney problems
- You are receiving concurrent nephrotoxic or ototoxic medications
Prolonged use of any antibiotic, including teicoplanin, may lead to overgrowth of non-susceptible organisms, including fungi. Your healthcare team will monitor for superinfection throughout your treatment course. Additionally, therapeutic drug monitoring (TDM) of teicoplanin trough levels is recommended in clinical practice to ensure adequate serum concentrations, particularly in serious infections such as endocarditis and osteomyelitis, where target trough levels of 15–30 mg/L are typically advised.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, talk to your doctor before receiving Teicoplanin Bradex. This medicine should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. There is a theoretical risk of damage to the developing inner ear (ototoxicity) and kidneys (nephrotoxicity) of the fetus, based on the pharmacological properties of glycopeptide antibiotics.
If you are breastfeeding, consult your doctor before treatment. The doctor will decide whether you can continue breastfeeding while being treated with Teicoplanin Bradex, taking into account the benefit of treatment for the mother and the potential risk to the infant.
In animal reproductive studies, teicoplanin did not show evidence of impaired fertility or teratogenic effects at therapeutic doses.
Driving and Using Machines
Teicoplanin Bradex may cause headache or dizziness in some patients. If you experience these effects, do not drive or operate machinery until you feel well enough to do so safely. You are responsible for assessing whether you are fit to drive or perform activities requiring alertness.
This medicine contains less than 1 mmol (23 mg) sodium per vial, meaning it is essentially sodium-free. This is important information for patients on a controlled sodium diet.
How Does Teicoplanin Bradex Interact with Other Drugs?
Drug interactions are an important consideration when using Teicoplanin Bradex. Although teicoplanin has relatively few pharmacokinetic interactions, the pharmacodynamic interactions with nephrotoxic and ototoxic drugs are clinically significant. Always inform your doctor or pharmacist about all medications you are currently taking, have recently taken, or plan to take.
The following drug interactions are of particular clinical importance:
Major Interactions
| Interacting Drug | Risk | Clinical Action |
|---|---|---|
| Aminoglycosides (gentamicin, tobramycin, amikacin) | Additive nephrotoxicity and ototoxicity; physical incompatibility | Must NOT be mixed in the same syringe or infusion line. Administer separately. Monitor renal function and hearing. |
| Amphotericin B | Increased risk of nephrotoxicity and ototoxicity | Monitor renal function closely. Consider dose adjustment based on creatinine clearance. |
| Cisplatin | Increased risk of nephrotoxicity and ototoxicity | Avoid concurrent use if possible. If necessary, intensive monitoring of renal function and audiometry is required. |
| Ciclosporin | Increased risk of nephrotoxicity | Monitor serum creatinine and ciclosporin levels frequently. Adjust doses as needed. |
| Loop diuretics (furosemide, bumetanide) | Increased risk of nephrotoxicity and ototoxicity | Monitor renal function and hearing. Use the lowest effective diuretic dose. |
Additional Considerations
Other potentially nephrotoxic agents, including non-steroidal anti-inflammatory drugs (NSAIDs), ACE inhibitors, and contrast media, should be used with caution during teicoplanin therapy. While formal interaction studies are limited, the theoretical risk of additive renal toxicity warrants careful monitoring when these agents are combined.
Teicoplanin does not appear to interact significantly with warfarin, digoxin, or common oral hypoglycaemic agents. However, as with any hospitalised patient receiving multiple medications, a thorough medication review should be performed by the clinical pharmacist or attending physician.
Never mix teicoplanin with aminoglycoside antibiotics in the same syringe, intravenous bag, or infusion line. These drugs are physically and chemically incompatible, and mixing them can result in precipitation and loss of activity for both antibiotics. Always administer them through separate lines or at different times.
What Is the Correct Dosage of Teicoplanin Bradex?
Teicoplanin Bradex is always administered by a healthcare professional in a hospital or clinical setting. The dose is individualised based on the type of infection, its severity, the patient's age, body weight, and renal function. The medicine can be given as a bolus intravenous injection over 3–5 minutes, as an intravenous infusion over 30 minutes, or as an intramuscular injection. For neonates up to 2 months of age, only intravenous infusion should be used.
Adults and Adolescents (12 Years and Older) with Normal Kidney Function
| Infection Type | Loading Dose | Maintenance Dose | Route |
|---|---|---|---|
| Skin, soft tissue, pneumonia, UTI | 6 mg/kg every 12 hours (3 doses) | 6 mg/kg once daily | IV or IM |
| Bone, joint, and heart infections (endocarditis) | 12 mg/kg every 12 hours (3–5 doses) | 12 mg/kg once daily | IV (loading); IV or IM (maintenance) |
| C. difficile infection | N/A | 100–200 mg orally twice daily for 7–14 days | Oral |
Children (2 Months to 12 Years)
Paediatric Dosing
- Loading dose: 10 mg/kg every 12 hours for the first 3 doses, given as an intravenous injection.
- Maintenance dose: 6–10 mg/kg once daily, given as an intravenous injection.
Neonates (Birth to 2 Months)
Neonatal Dosing
- Loading dose (Day 1): 16 mg/kg as a single intravenous infusion.
- Maintenance dose: 8 mg/kg once daily by intravenous infusion.
Important: Only intravenous infusion (not bolus injection) may be used for neonates from birth to 2 months of age.
Dose Adjustment for Kidney Impairment
Patients with impaired kidney function require dose adjustments starting from the fourth day of treatment. Loading doses remain the same, but maintenance doses are modified as follows:
| Kidney Function | Option A | Option B |
|---|---|---|
| Mild to moderate impairment | Full maintenance dose every 2 days | Half the maintenance dose once daily |
| Severe impairment or haemodialysis | Full maintenance dose every 3 days | One-third of maintenance dose once daily |
Peritonitis in Peritoneal Dialysis Patients
For patients undergoing continuous ambulatory peritoneal dialysis (CAPD) who develop peritonitis, a specific regimen is used:
- Loading dose: 6 mg/kg as a single intravenous injection
- Week 1: 20 mg/L added to every dialysis bag
- Week 2: 20 mg/L added to every other dialysis bag
- Week 3: 20 mg/L added to the overnight dialysis bag only
Missed Dose
Since Teicoplanin Bradex is administered by healthcare professionals in a hospital setting, it is unlikely that a dose will be missed. Your clinical team follows a strict dosing schedule. If you have concerns about whether you have received all your scheduled doses, speak with your nurse or doctor.
Overdose
Overdose with teicoplanin is unlikely in a hospital setting, as doses are carefully calculated by healthcare professionals. In the event of accidental overdose, treatment is supportive and symptomatic. There is no specific antidote. Teicoplanin is not significantly removed by haemodialysis due to its high protein binding (approximately 90%). If you suspect an overdose, contact your medical team immediately.
It is important to complete the full course of antibiotic therapy as prescribed by your doctor, even if you start to feel better. Stopping treatment too early may allow bacteria to survive and multiply, potentially leading to treatment failure or the development of antibiotic-resistant organisms.
What Are the Side Effects of Teicoplanin Bradex?
Like all medicines, Teicoplanin Bradex can cause side effects, although not everybody gets them. Most side effects are mild to moderate in severity and resolve after treatment is completed. However, some side effects can be serious and require immediate medical attention.
Serious Side Effects – Seek Immediate Medical Help
Stop treatment and tell your doctor or nurse immediately if you experience any of the following serious side effects:
Uncommon
- Sudden life-threatening allergic reaction (anaphylaxis) – signs may include difficulty breathing, wheezing, swelling of the face or throat, rash, itching, fever, chills
- Swelling and blood clot in a vein (thrombophlebitis)
- Difficulty breathing or wheezing (bronchospasm)
- Increased frequency of infections – may indicate a decrease in white blood cell count
Rare
- Red man syndrome – flushing and redness of the upper body, typically related to infusion rate
Frequency Not Known
- Blistering of the skin, mouth, eyes, or genitals (Stevens-Johnson syndrome or toxic epidermal necrolysis)
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) – initially flu-like symptoms with facial rash, then more widespread rash, high fever, elevated liver enzymes, eosinophilia, and enlarged lymph nodes
- Severe lack of white blood cells (agranulocytosis) – signs include fever, severe chills, sore throat, or mouth ulcers
- Low levels of all types of blood cells (pancytopenia)
- Kidney problems or changes in kidney function
- Seizures (epileptic fits)
Other Side Effects
Common
- Rash, skin redness, itching
- Pain at the injection site
- Fever
Uncommon
- Decreased platelet count (thrombocytopenia)
- Elevated liver enzymes in blood tests
- Elevated creatinine levels (indicates kidney stress)
- Hearing impairment, ringing in the ears (tinnitus), or dizziness/vertigo
- Nausea, vomiting, or diarrhea
- Dizziness or headache
Rare
- Abscess (localised collection of pus)
Frequency Not Known
- Injection site reactions – redness, pain, or swelling at the site of injection
The severity and frequency of kidney-related side effects may increase with higher doses. Your medical team will monitor your kidney function throughout treatment and adjust the dose if necessary.
Contact your doctor or nurse immediately if you develop signs of a severe allergic reaction (difficulty breathing, facial swelling, widespread rash), signs of Stevens-Johnson syndrome (blistering of skin or mucous membranes), or signs of a blood disorder (unexplained fever, sore throat, unusual bleeding, or bruising). These conditions require urgent medical assessment and treatment.
If you notice any side effects not listed here, or if any of the listed side effects become severe, tell your doctor, pharmacist, or nurse. You can also report side effects directly to your national pharmacovigilance authority to help ensure ongoing monitoring of the medicine's benefit-risk balance.
How Should You Store Teicoplanin Bradex?
Keep this medicine out of the sight and reach of children at all times. Do not use Teicoplanin Bradex after the expiry date printed on the carton and vials after “EXP”. The expiry date refers to the last day of the stated month.
The unopened powder and solvent packaged for sale do not require any special storage conditions. They can be kept at room temperature.
Reconstituted Solution
Teicoplanin Bradex is for single use only. Any unused solution must be discarded. The stability of the reconstituted solution has been demonstrated as follows:
- Reconstituted solution: Stable for up to 24 hours when stored at 2–8°C (refrigerated).
- Further diluted solution (4–20 mg/mL): Stable for an additional 24 hours at 2–8°C after the initial 24-hour reconstitution period.
From a microbiological standpoint, the reconstituted product should be used immediately unless the method of preparation excludes the risk of microbial contamination. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the healthcare professional.
Do not dispose of medicines via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help to protect the environment.
What Does Teicoplanin Bradex Contain?
Teicoplanin Bradex is supplied as a white to pale yellow powder in a glass vial, together with a clear, colourless solvent (water for injections) in a separate ampoule. The powder is sealed with a rubber stopper and an aluminium cap with a plastic flip-off top. The solvent ampoule has a twist-off cap.
Composition
- Active substance: Teicoplanin – 200 mg or 400 mg per vial
- Excipients (powder): Sodium chloride, sodium hydroxide (for pH adjustment)
- Solvent: Water for injections (3 mL ampoule)
Pack Sizes
- 1 vial × 200 mg + 1 ampoule × 3 mL solvent
- 10 vials × 200 mg + 10 ampoules × 3 mL solvent
- 1 vial × 400 mg + 1 ampoule × 3 mL solvent
- 10 vials × 400 mg + 10 ampoules × 3 mL solvent
Not all pack sizes may be marketed in your country.
Reconstitution and Dilution (Healthcare Professionals)
For healthcare professionals preparing the medicine: inject 3 mL of the supplied diluent slowly into the vial containing the powder. Roll the vial gently between your hands until the powder is completely dissolved. If foam forms, allow the solution to stand for approximately 15 minutes. Only use clear, pale yellow solution. The reconstituted solution is isotonic and does not require further dilution before injection.
For intravenous infusion, the reconstituted solution may be further diluted to concentrations between 4 mg/mL and 20 mg/mL using the following compatible solutions:
- Sodium chloride 0.9%
- Glucose 5%
- Ringer-lactate solution
- Sodium chloride 0.18% / Glucose 4%
- Peritoneal dialysis solutions (glucose 1.36% or 3.86%)
- Ringer's solution
- Glucose 10%
- Sodium chloride 0.45% / Glucose 5%
The reconstituted solution has an osmolality of 264–275 mOsm/kg (200 mg) and 285–305 mOsm/kg (400 mg), with a pH of 7.2–7.8.
BRADEX S.A., 27 Asklipiou street, 14568 Kryoneri, Greece. Manufactured by DEMO S.A. Pharmaceutical Industry, 21st km National Road Athens–Lamia, 14568 Krioneri, Attiki, Greece.
Frequently Asked Questions About Teicoplanin Bradex
Teicoplanin Bradex is a glycopeptide antibiotic used to treat serious bacterial infections caused by Gram-positive organisms. These include skin and soft tissue infections, bone and joint infections (osteomyelitis, septic arthritis), pneumonia, urinary tract infections, infective endocarditis (heart valve infection), peritonitis, and bloodstream infections (bacteremia). It can also be taken orally as a solution to treat Clostridioides difficile infections of the bowel. It is particularly valuable for treating infections caused by methicillin-resistant Staphylococcus aureus (MRSA).
Although both teicoplanin and vancomycin are glycopeptide antibiotics with similar spectrums of activity, they have important practical differences. Teicoplanin has a much longer half-life (70–100 hours versus 4–6 hours for vancomycin), which means it can be given once daily after the initial loading phase, compared to vancomycin's twice-daily dosing. Teicoplanin can be administered intramuscularly as well as intravenously, whereas vancomycin can only be given intravenously (due to local tissue irritation with IM injection). Red man syndrome, an infusion-related flushing reaction, occurs less frequently with teicoplanin. Both drugs require therapeutic drug monitoring for optimal outcomes.
If you experience mild side effects such as pain at the injection site, mild rash, or headache, inform your nurse or doctor so they can assess whether any adjustment to your treatment is needed. For serious side effects – including signs of an allergic reaction (difficulty breathing, facial swelling, widespread rash), blistering of skin or mucous membranes, unexplained fever with sore throat, or unusual bleeding or bruising – seek immediate medical attention. Your treatment may need to be stopped and alternative therapy started. You should also report any suspected side effects to your national pharmacovigilance authority.
Yes, Teicoplanin Bradex is approved for use in children of all ages, including neonates (newborn babies). However, dosing is different from adults and is carefully calculated based on the child's body weight and age. For neonates (birth to 2 months), only intravenous infusion (not injection) may be used, with a loading dose of 16 mg/kg on Day 1 followed by 8 mg/kg once daily. Children aged 2 months to 12 years receive a loading dose of 10 mg/kg every 12 hours for 3 doses, then 6–10 mg/kg once daily. All paediatric dosing is managed by the treating physician in a hospital setting.
Yes, therapeutic drug monitoring (TDM) is recommended for teicoplanin, particularly for serious infections such as endocarditis, osteomyelitis, and bacteremia. Trough (pre-dose) serum levels are measured to ensure adequate drug exposure. For most infections, a trough level of at least 10 mg/L is recommended. For more serious infections like endocarditis and osteomyelitis, higher trough targets of 15–30 mg/L are advised. TDM helps optimise efficacy while minimising the risk of toxicity, and is particularly important in patients with renal impairment, neonates, critically ill patients, and those on prolonged therapy.
This information is based on the approved Summary of Product Characteristics (SmPC) from the European Medicines Agency (EMA), the WHO Model List of Essential Medicines, IDSA/ASHP guidelines for the treatment of MRSA infections, the British National Formulary (BNF), and peer-reviewed clinical pharmacology literature. Key references include systematic reviews published in the Journal of Antimicrobial Chemotherapy and Clinical Infectious Diseases. All medical claims follow evidence level 1A standards based on systematic reviews of randomised controlled trials and established clinical guidelines.
References
- European Medicines Agency (EMA). Teicoplanin – Summary of Product Characteristics. EMA Product Information. Available at: www.ema.europa.eu.
- World Health Organization. WHO Model List of Essential Medicines – 23rd List, 2023. Geneva: WHO; 2023.
- Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18–e55.
- Joint Formulary Committee. British National Formulary (BNF). London: BMJ Group and Pharmaceutical Press; 2025. Teicoplanin monograph.
- Wilson AP. Clinical pharmacokinetics of teicoplanin. Clin Pharmacokinet. 2000;39(3):167–183.
- Pea F, Broeker A, Tascini C, et al. Therapeutic drug monitoring of teicoplanin: a retrospective analysis. J Antimicrob Chemother. 2020;75(6):1485–1491.
- Svetitsky S, Leibovici L, Paul M. Comparative efficacy and safety of vancomycin versus teicoplanin: systematic review and meta-analysis. Antimicrob Agents Chemother. 2009;53(10):4069–4079.
- McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by IDSA and SHEA. Clin Infect Dis. 2018;66(7):e1–e48.
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This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians in infectious disease, clinical pharmacology, and internal medicine. Our team follows international clinical guidelines from the WHO, EMA, IDSA, and ESCMID. All content undergoes multi-stage review including medical accuracy verification, evidence grading using the GRADE framework, and readability assessment.
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