Nandí-Lozano Eugenia, Ramírez-López Eduardo, Avila-Figueroa Carlos
Departamento de Enseñanza del Hospital de Niño Morelense.
Rev Invest Clin. 2003 May-Jun;55(3):276-80.
To analyze the results from the clinical monitoring of serum vancomycin levels among pediatric patients receiving this drug.
Retrospective study of data from routine monitoring of serum vancomycin concentrations. The study population includes children who received vancomycin for more than 3 days and had peak and trough vancomycin serum concentration documented. The vancomycin concentrations were measured by an immunoassay procedure.
We obtained 70 vancomycin concentrations from pediatric patients whose ages ranged from newborn to 13 years old. Mean peak and trough concentrations were 45.7 +/- 8.0 and 18.7 +/- 9.6 micrograms/mL, respectively. We used as a reference normal ranges for Cpmax of 25-40 micrograms/mL and Cpmin of 5-40 micrograms/mL. Only 26.1% of the patients were on Cpmax normal ranges, 47.8% were above the range and 26% under the lower limit. In regards to the Cpmin 17% of the cases were between the accepted limits, 41% above the upper limit and 41% under the normal range.
Our data suggest that less than a fifth of the patients have serum levels on therapeutic range and almost half of these population had serum levels above the normal range. This might be explained by the type of the population sampled, reflecting a selection bias by detecting levels only among patients with an increased risk for toxicity. Finally, we stress the importance of accurately documenting dose, timing, and renal function in the records of all patients subjected to serum vancomycin determinations.
分析接受万古霉素治疗的儿科患者血清万古霉素水平的临床监测结果。
对血清万古霉素浓度常规监测数据进行回顾性研究。研究人群包括接受万古霉素治疗超过3天且有万古霉素血清峰浓度和谷浓度记录的儿童。万古霉素浓度通过免疫测定法测量。
我们获得了70例年龄从新生儿到13岁的儿科患者的万古霉素浓度。平均峰浓度和谷浓度分别为45.7±8.0和18.7±9.6微克/毫升。我们将25 - 40微克/毫升的Cpmax和5 - 40微克/毫升的Cpmin作为参考正常范围。只有26.1%的患者Cpmax在正常范围内，47.8%高于该范围，26%低于下限。关于Cpmin，17%的病例在可接受范围内，41%高于上限，41%低于正常范围。
我们的数据表明，不到五分之一的患者血清水平处于治疗范围内，且几乎一半的人群血清水平高于正常范围。这可能是由于所抽样人群的类型所致，反映出仅在毒性风险增加的患者中检测水平存在选择偏倚。最后，我们强调在所有接受血清万古霉素测定的患者记录中准确记录剂量、时间和肾功能的重要性。
