Faculty of Pharmacy, Siam University, Bangkok 10160, Thailand.
Int J Antimicrob Agents. 2011 Aug;38(2):152-6. doi: 10.1016/j.ijantimicag.2011.04.010. Epub 2011 Jun 1.
The objective of this study was to determine the pharmacokinetics and dosing recommendations of vancomycin in critically ill patients receiving continuous venovenous haemofiltration (CVVH). A prospective study was conducted in the Intensive Care Unit of a university hospital. Seven patients receiving CVVH with a triacetate hollow-fibre dialyser were enrolled. CVVH was performed in pre-dilution mode with a blood flow rate of 200-250 mL/min and an ultrafiltrate flow rate of 800-1200 mL/h. To determine vancomycin pharmacokinetics, serum and ultrafiltrate were collected over 12 h after a 2-h infusion of 1000 mg vancomycin. The mean (± standard deviation) sieving coefficient of vancomycin was 0.71±0.13, which is consistent with previously reported values. Clearance of vancomycin by CVVH (0.73±0.21 L/h or 12.11±3.50 mL/min) constituted 49.4±20.8% of total vancomycin clearance (1.59±0.47 L/h) and was consistent with previously reported clearances. Approximately one-fifth of the vancomycin dose was removed during the 12-h CVVH (213.9±104.0 mg). The volume of distribution was 24.69±11.00 L, which is smaller than previously reported. The elimination rate constant and terminal half-life were 0.08±0.05 h(-1) and 12.02±7.00 h, respectively. In conclusion, elimination of vancomycin by CVVH contributed to ca. 50% of the total elimination in critically ill patients. The maintenance dose of vancomycin, calculated from parameters from patients in this study, would be 500-750 mg every 12 h to provide a steady-state trough concentration of 15-20 mg/L. Owing to alterations in clinical conditions, serum vancomycin concentrations must be closely monitored in critically ill patients.
本研究旨在确定接受连续静脉-静脉血液滤过（CVVH）治疗的危重症患者万古霉素的药代动力学和给药建议。一项前瞻性研究在一所大学医院的重症监护病房进行。纳入了 7 名接受三醋酸酯空心纤维透析器 CVVH 的患者。CVVH 以预稀释模式进行，血流速度为 200-250mL/min，超滤液流速为 800-1200mL/h。为了确定万古霉素的药代动力学，在输注万古霉素 1000mg 2 小时后 12 小时内采集血清和超滤液。万古霉素的平均（±标准差）筛系数为 0.71±0.13，与之前报道的值一致。CVVH 清除万古霉素的速度（0.73±0.21 L/h 或 12.11±3.50 mL/min）占万古霉素总清除率（1.59±0.47 L/h）的 49.4±20.8%，与之前报道的清除率一致。大约有五分之一的万古霉素剂量在 12 小时的 CVVH 中被清除（213.9±104.0mg）。分布容积为 24.69±11.00L，小于之前报道的值。消除率常数和终末半衰期分别为 0.08±0.05h(-1)和 12.02±7.00h。总之，CVVH 清除万古霉素约占危重症患者总清除率的 50%。根据本研究患者的参数计算的万古霉素维持剂量将为每 12 小时 500-750mg，以提供 15-20mg/L 的稳态谷浓度。由于临床情况的改变，必须密切监测危重症患者的血清万古霉素浓度。
