基于新生儿重症监护病房使用的血清肌酐评估万古霉素给药方案。

Evaluation of the vancomycin dosage regimen based on serum creatinine used in the neonatal intensive care unit.

作者信息

Irikura Mitsuru, Fujiyama Ayako, Saita Fumi, Fukushima Shiori, Kitaoka Hiroki, Fukuda Terumi, Kawase Akihiko, Kondo Yuichi, Ishitsuka Yoichi, Kondo Genzo, Maeda Toshihide, Yukawa Eiji, Irie Tetsumi

机构信息

Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.

出版信息

Pediatr Int. 2011 Dec;53(6):1038-44. doi: 10.1111/j.1442-200X.2011.03441.x.

DOI:10.1111/j.1442-200X.2011.03441.x

PMID:21810150

Abstract

BACKGROUND

Vancomycin is frequently used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections; however, determining the optimal dosage for neonates is difficult because of their immature renal function.

METHODS

Serum creatinine-based dosing was introduced in Kumamoto City Hospital Neonatal Medical Center. Serum trough concentration and therapeutic efficacy of vancomycin were evaluated before and after the introduction of the creatinine-based dosing.

RESULTS

When the therapeutic range of serum trough concentration of vancomycin at steady state was set to 5-15 µg/mL, 20 trough concentrations (48.8%) were within the therapeutic range and 21 trough concentrations were outside the therapeutic range before the introduction of the serum creatinine-based dosing. After the introduction of serum creatinine-based dosing, 18 trough concentrations (81.8%) were within the therapeutic range and 4 trough concentrations were not, and there was an increase in the number of patients with trough concentrations in the therapeutic range (P= 0.01; Fisher's exact test).

CONCLUSIONS

The serum creatinine-based dosing of vancomycin is useful in maintaining the appropriate serum level of vancomycin in neonates.

摘要

背景

万古霉素常用于治疗耐甲氧西林金黄色葡萄球菌（MRSA）感染；然而，由于新生儿肾功能不成熟，确定其最佳剂量很困难。

方法

熊本市立医院新生儿医疗中心引入了基于血清肌酐的给药方法。在引入基于肌酐的给药方法前后，评估了万古霉素的血清谷浓度和治疗效果。

结果

当将稳态下万古霉素血清谷浓度的治疗范围设定为5 - 15μg/mL时，在引入基于血清肌酐的给药方法之前，20个谷浓度（48.8%）在治疗范围内，21个谷浓度超出治疗范围。引入基于血清肌酐的给药方法后，18个谷浓度（81.8%）在治疗范围内，4个谷浓度不在治疗范围内，且治疗范围内谷浓度的患者数量有所增加（P = 0.01；Fisher精确检验）。