Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, 73117, USA.
Am J Health Syst Pharm. 2011 Nov 1;68(21):2062-8. doi: 10.2146/ajhp110107.
Vancomycin dosages in overweight and obese children were evaluated.
This retrospective study evaluated data for children who were age 2-17 years, received i.v. vancomycin, and were admitted to a children's hospital from September 1, 2007, through October 31, 2009. Patients were then stratified into two groups: normal-weight patients and overweight or obese patients. The primary objective was to compare the number of vancomycin regimens between groups with a trough concentration of 5-15 μg/mL. Secondary objectives included a comparison of dosage changes and toxicities. Multivariate, conditional logistic regression was performed to assess the relationship between attaining optimal vancomycin concentrations (5-15 μg/mL) and independent variables.
Data were collected for 232 courses of vancomycin, representing 187 patients. The mean ± S.D. initial dose for the normal-weight and overweight or obese groups differed significantly (461.3 ± 303.1 mg and 658.4 ± 389.6 mg, respectively; p < 0.01); the milligram-per-kilogram initial vancomycin dose did not. The multivariate analysis revealed that every-eight-hour regimens had increased odds of achieving therapeutic concentrations (p < 0.001), while obese children had decreased odds of achieving therapeutic concentrations (p = 0.037).
A study of prescribing behavior in one hospital revealed no significant difference in the size of vancomycin doses (in milligrams per kilogram) given to normal-weight children compared with overweight or obese children. Regimens using every-eight-hour dosing were significantly more likely than other regimens to result in a vancomycin trough concentration of 5-15 μg/mL, and regimens for obese children, compared with regimens for nonobese children, were less likely to produce trough concentrations in the same range of 5-15 μg/mL.
评估超重和肥胖儿童中万古霉素的剂量。
本回顾性研究评估了 2007 年 9 月 1 日至 2009 年 10 月 31 日期间在一家儿童医院接受静脉万古霉素治疗且年龄在 2-17 岁的儿童的数据。患者随后分为两组：正常体重患者和超重或肥胖患者。主要目标是比较两组之间具有 5-15μg/mL 谷浓度的万古霉素方案数量。次要目标包括比较剂量变化和毒性。采用多变量条件逻辑回归评估达到最佳万古霉素浓度（5-15μg/mL）与独立变量之间的关系。
共收集了 232 个万古霉素疗程，代表了 187 名患者的数据。正常体重组和超重或肥胖组的初始剂量均值±标准差差异显著（分别为 461.3±303.1mg 和 658.4±389.6mg；p<0.01）；而每 8 小时给药的初始万古霉素剂量没有差异。多变量分析显示，每 8 小时一次的方案具有更高的获得治疗浓度的几率（p<0.001），而肥胖儿童获得治疗浓度的几率降低（p=0.037）。
对一家医院的处方行为进行的研究表明，与正常体重儿童相比，超重或肥胖儿童的万古霉素剂量（毫克/千克）没有显著差异。与其他方案相比，每 8 小时一次的方案更有可能导致万古霉素谷浓度为 5-15μg/mL，与非肥胖儿童相比，肥胖儿童的方案更不可能产生 5-15μg/mL 的谷浓度范围。
