Glover M L, Cole E, Wolfsdorf J
Division of Critical Care Medicine, Miami Children's Hospital, FL 33155-3009, USA.
J Crit Care. 2000 Mar;15(1):1-4. doi: 10.1053/jcrc.2000.0150001.
The purpose of this study was to determine a vancomycin dosage regimen among pediatric intensive care unit (PICU) patients with normal renal function resulting in desired peak and trough serum concentration and to determine the predictability of vancomycin peak concentrations based on reported trough concentrations.
The medical records of all PICU patients who received vancomycin over a 12-month period were identified through a hospital computer search and were obtained from the hospital's Department of Medical Records. Demographic and laboratory data as well as the patient's vancomycin dosing history were recorded. Patients who lacked appropriately timed vancomycin peak and trough concentrations or who exhibited renal dysfunction were excluded from the study population. The optimal vancomycin dose and the predictability of peak concentrations based on trough concentrations were assessed.
A total of 135 patients were identified as having received vancomycin therapy during their PICU hospitalization between June 1997 and June 1998. Fifty-nine patients were excluded due to renal dysfunction or inappropriate vancomycin concentrations resulting in 76 patients representing our study population. The initial mean dose of vancomycin was 47 mg/kg/day resulting in a mean peak and trough serum concentration of 19 and 6 microg/mL, respectively. A mean of 2.2 (range, 1 to 5) and 2.1 (range, 1 to 5) peak and trough serum concentrations were reported for each patient, respectively. A mean of 1.1 (range, 0 to 4) dosing changes per patient was noted resulting in a final mean dose of 60 mg/kg/day corresponding to a mean peak and trough serum concentration of 26 and 8 microg/mL, respectively. A vancomycin trough concentration >5 microg/mL was highly predictive for a corresponding peak concentration >20 microg/mL (P > .0001). Eighty percent of the trough concentrations <5 microg/mL were associated with peak concentrations <20 microg/mL, whereas 81% of trough concentrations >5 microg/mL were associated with corresponding peak concentrations >20 microg/mL.
PICU patients required higher doses of vancomycin than are typically prescribed to achieve conventionally accepted peak and trough vancomycin serum concentrations. In the absence of renal impairment, we recommend an initial dosage regimen of 60 mg/kg/day divided every 8 hours. Vancomycin trough concentrations are highly predictive of corresponding peak concentrations and therefore may negate the need to obtain routine peak concentrations.
本研究旨在确定肾功能正常的儿科重症监护病房（PICU）患者的万古霉素给药方案，以达到理想的血清峰浓度和谷浓度，并根据报告的谷浓度确定万古霉素峰浓度的可预测性。
通过医院计算机检索确定了在12个月期间接受万古霉素治疗的所有PICU患者的病历，并从医院病历部门获取。记录人口统计学和实验室数据以及患者的万古霉素给药史。缺乏适当时间的万古霉素峰浓度和谷浓度或存在肾功能障碍的患者被排除在研究人群之外。评估了最佳万古霉素剂量以及基于谷浓度的峰浓度的可预测性。
共有135例患者被确定在1997年6月至1998年6月期间在PICU住院期间接受了万古霉素治疗。59例患者因肾功能障碍或万古霉素浓度不当而被排除，76例患者代表我们的研究人群。万古霉素的初始平均剂量为47mg/kg/天，导致平均血清峰浓度和谷浓度分别为19μg/mL和6μg/mL。每位患者报告的平均血清峰浓度和谷浓度分别为2.2（范围1至5）和2.1（范围1至5）。每位患者平均有1.1（范围0至4）次剂量调整，最终平均剂量为60mg/kg/天，对应平均血清峰浓度和谷浓度分别为26μg/mL和8μg/mL。万古霉素谷浓度>5μg/mL对相应峰浓度>20μg/mL具有高度预测性（P>.0001）。80%的谷浓度<5μg/mL与峰浓度<20μg/mL相关，而81%的谷浓度>5μg/mL与相应峰浓度>20μg/mL相关。
PICU患者需要比通常规定的更高剂量的万古霉素，以达到传统上认可的万古霉素血清峰浓度和谷浓度。在没有肾功能损害的情况下，我们建议初始给药方案为60mg/kg/天，每8小时一次。万古霉素谷浓度对相应的峰浓度具有高度预测性，因此可能无需常规获取峰浓度。
