Pea Federico, Brollo Loris, Viale Pierluigi, Pavan Federica, Furlanut Mario
Institute of Clinical Pharmacology & Toxicology, Department of Experimental and Clinical Pathology and Medicine, Medical School, University of Udine, P.le S. Maria della Misericordia 3, 33100 Udine, Italy.
J Antimicrob Chemother. 2003 Apr;51(4):971-5. doi: 10.1093/jac/dkg147. Epub 2003 Feb 25.
Data obtained as part of our routine drug monitoring of teicoplanin therapy (therapeutic drug monitoring, TDM) in adult critically ill patients being treated for suspected or documented Gram-positive multiresistant infections were assessed, retrospectively. Data were available for 202 patients (146 male, 56 female; age 58 +/- 16 years) with a total number of 829 teicoplanin trough plasma levels (C(min)) assessed. The percentage of patients with adequate teicoplanin concentrations (C(min) >/= 10 mg/L) during the treatment period substantially increased from 3.2% on day 2, to 35%, 70%, 90% and approximately 95% on days 4, 7, 11 and 15, respectively. The findings suggest that optimal teicoplanin therapy was achieved only after at least 4, and probably 7, days of therapy in most cases, mainly because of a failure to use an appropriate loading dose. Among the possible causes for the reluctance to use a loading dose, concern over the potential nephrotoxicity of teicoplanin was a major factor. We conclude that loading doses of teicoplanin (6 mg/kg every 12 h for at least three doses) must be considered mandatory in all patients, regardless of their renal function, to enable optimal drug concentrations to be achieved early in the treatment period. Subsequently, TDM is important to ensure that dose regimens are optimized to the individual requirements of the patients.
作为我们对疑似或确诊革兰氏阳性多重耐药感染的成年重症患者进行替考拉宁治疗常规药物监测（治疗药物监测，TDM）的一部分所获得的数据进行了回顾性评估。共有202例患者（146例男性，56例女性；年龄58±16岁）的数据可用，共评估了829次替考拉宁谷浓度（C(min)）。治疗期间替考拉宁浓度充足（C(min)≥10mg/L）的患者百分比从第2天的3.2%大幅增加到第4天、第7天、第11天和第15天的35%、70%、90%和约95%。研究结果表明，在大多数情况下，只有在治疗至少4天，可能7天后才能实现最佳替考拉宁治疗，主要原因是未使用适当的负荷剂量。在不愿使用负荷剂量的可能原因中，对替考拉宁潜在肾毒性的担忧是一个主要因素。我们得出结论，所有患者无论肾功能如何，都必须考虑强制使用替考拉宁负荷剂量（每12小时6mg/kg，至少三剂），以便在治疗早期达到最佳药物浓度。随后，TDM对于确保剂量方案根据患者的个体需求进行优化很重要。
