Ochi H, Wada K, Okada H, Kohara N, Fujita T, Toda K, Sakamoto M, Seguchi O, Murata Y, Yanase M, Nakatani T
Departments of Pharmacy, National Cardiovascular Center, Osaka, Japan.
Int J Clin Pharmacol Ther. 2011 May;49(5):339-43. doi: 10.5414/cp201430.
It was reported that the drug-induced fever of teicoplanin tended to persist after cessation of treatment. It is considered that the long half-life of teicoplanin causes the phenomenon. However there was no detailed report regarding plasma concentration of teicoplanin during onset of drug induced-fever. Therefore we investigated the relation between persistence of drug-induced fever and plasma concentration of teicoplanin.
A 38-year-old male patient on the Left Ventricular Assist System (LVAS) was treated with teicoplanin for methicillin-resistant Staphylococcus aureus (MRSA) and he experienced drug-induced fever. Plasma concentrations of teicoplanin were measured not only during the treatment with the drug but also after it was discontinued. As such, plasma concentration was measured even when the fever had subsided.
On Day 9 of treatment, the dose was increased from 400 to 600 mg, but the patient had a fever of about 38 - 39 °C. When the treatment was discontinued, it took 9 days for the fever to subside to a temperature of about 37 °C. The half-life of elimination of teicoplanin in the elimination phase is about 108 h, which is long. The fever persisted until the plasma concentration decreased to below 10 µg/ml, which is the effective trough concentration, and subsided when the estimated blood concentration was 7.5 µg/ml.
We suggest that there is the possibility that the drug-induced fever due to teicoplanin persisted until the plasma concentration had decreased adequately. Close monitoring of plasma concentration is necessary, particularly when teicoplanin clearance is decreased such as in patients with renal dysfunction.
据报道，替考拉宁引起的药物性发热在治疗停止后往往会持续。人们认为替考拉宁的半衰期长导致了这种现象。然而，关于药物性发热发作期间替考拉宁的血浆浓度尚无详细报告。因此，我们研究了药物性发热的持续时间与替考拉宁血浆浓度之间的关系。
一名38岁接受左心室辅助系统（LVAS）治疗的男性患者因耐甲氧西林金黄色葡萄球菌（MRSA）感染接受替考拉宁治疗，并出现了药物性发热。不仅在用药治疗期间，而且在停药后都对替考拉宁的血浆浓度进行了测量。即便在发热消退后也进行了血浆浓度测量。
在治疗的第9天，剂量从400毫克增加到600毫克，但患者仍有大约38 - 39摄氏度的发热。停药后，发热持续9天才消退至约37摄氏度。替考拉宁在消除相的消除半衰期约为108小时，较长。发热一直持续到血浆浓度降至有效谷浓度以下10微克/毫升，当估计血药浓度为7.5微克/毫升时发热消退。
我们认为替考拉宁引起的药物性发热有可能一直持续到血浆浓度充分下降。有必要密切监测血浆浓度，尤其是在替考拉宁清除率降低的情况下，如肾功能不全患者。
