Birt J K, Chandler M H
Division of Clinical Practice, College of Pharmacy, University of Kentucky, Lexington.
Ther Drug Monit. 1990 Mar;12(2):206-9. doi: 10.1097/00007691-199003000-00017.
The serum concentrations and pharmacokinetic parameters produced from standard doses of vancomycin were evaluated in 22 patients. The mean (+/- SD) half-life, clearance (Cl), and volume of distribution, respectively, were 6.2 (+/- 1.9) h, 79.2 (+/- 34.3) ml/min, and 0.54 (+/- 0.23) L/kg. Geometric regression analysis was used to determine significant correlations between Cl and creatinine clearance (CrCl) (p less than 0.001). The dosing method developed is based on the pharmacokinetic parameters of vancomycin derived from our patient data and the relationship between Cl and CrCl described by the following equation, Cl = (0.674) (CrCl) + 13.45 (r = 0.703). Predictive performance measures were used to compare our dosing method with that of the Matzke nomogram. Our method was found to be less biased and more precise in regards to predicted half-life and volume of distribution, while less biased with no difference in precision in regard to predicting clearance. We plan to use this dosing method at our institution to provide a more individualized initial dosing regimen for vancomycin. Other institutions may wish to use a similar approach to design a dosing nomogram specific for their patient population.
对22例患者评估了标准剂量万古霉素产生的血清浓度和药代动力学参数。平均（±标准差）半衰期、清除率（Cl）和分布容积分别为6.2（±1.9）小时、79.2（±34.3）毫升/分钟和0.54（±0.23）升/千克。采用几何回归分析确定Cl与肌酐清除率（CrCl）之间的显著相关性（p<0.001）。所开发的给药方法基于从我们的患者数据得出的万古霉素药代动力学参数以及由以下方程描述的Cl与CrCl之间的关系，Cl =（0.674）（CrCl）+ 13.45（r = 0.703）。使用预测性能指标将我们的给药方法与Matzke列线图的给药方法进行比较。结果发现，就预测半衰期和分布容积而言，我们的方法偏差较小且更精确，而就预测清除率而言，偏差较小且精度无差异。我们计划在我们机构使用这种给药方法，为万古霉素提供更个体化的初始给药方案。其他机构可能希望采用类似方法来设计针对其患者群体的给药列线图。
