Carricajo A, Forgeot A, Morel J, Auboyer C, Zeni F, Aubert G
Laboratoire de bactériologie-virologie, CHU de Saint-Etienne, avenue A.-Raimond, 42277 Saint-Priest-en-Jarez, France.
Ann Fr Anesth Reanim. 2010 Jan;29(1):55-7. doi: 10.1016/j.annfar.2009.12.002. Epub 2010 Jan 13.
As the susceptibility of staphylococcal strains to glycopeptides rises, it is becoming necessary to increase vancomycin dosages.
To evaluate an administration protocol for vancomycin using continuous infusion with a loading dose of 30 mg/kg followed by 30 mg/kg per 24h in intensive care patients presenting creatinine clearance (CLc) greater than 50.
A total of 22 patients were included in the study. Serum vancomycin concentrations after 24h (C24h) ranged from 25 to 30 mg/l in seven of 14 patients with CLc less than 120 ml/min (50 %), compared with three patients (21 %) with C24h greater than 35 mg/l and four patients (29 %) with C24 h less than 25 mg/l. However, C24h was less than 20mg/l for the eight patients with CLc greater or equal to 120 ml/min. Bacteriological data was available for eight of the 14 patients with CLc less than 120 ml/min, and in these eight patients, the C24h/MIC was greater or equal to 8; seven of these patients had an AUC/MIC greater or equal to 350.
Assay of serum vancomycin concentrations after 24h of treatment is necessary to enable rapid adjustment of vancomycin concentration in order to improve therapeutic efficacy or avoid nephrotoxicity.
随着葡萄球菌菌株对糖肽类药物的敏感性增加，提高万古霉素剂量变得很有必要。
评估一种万古霉素给药方案，即对肌酐清除率（CLc）大于50的重症监护患者采用持续输注，负荷剂量为30mg/kg，随后每24小时30mg/kg。
共有22名患者纳入研究。在CLc小于120ml/min的14名患者中，有7名患者（50%）治疗24小时后的血清万古霉素浓度（C24h）在25至30mg/l之间，相比之下，C24h大于35mg/l的患者有3名（21%），C24h小于25mg/l的患者有4名（29%）。然而，CLc大于或等于120ml/min的8名患者的C24h小于20mg/l。在CLc小于120ml/min的14名患者中，有8名患者可获得细菌学数据，在这8名患者中，C24h/MIC大于或等于8；其中7名患者的AUC/MIC大于或等于350。
治疗24小时后检测血清万古霉素浓度对于快速调整万古霉素浓度以提高治疗效果或避免肾毒性是必要的。
