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快速达到替考拉宁治疗性血药谷浓度所需的负荷方案及临床特征评估。

Loading regimen required to rapidly achieve therapeutic trough plasma concentration of teicoplanin and evaluation of clinical features.

作者信息

Seki Masafumi, Yabuno Kaori, Miyawaki Koji, Miwa Yoshihiro, Tomono Kazunori

机构信息

Division of Infection Control and Prevention.

出版信息

Clin Pharmacol. 2012;4:71-5. doi: 10.2147/CPAA.S37528. Epub 2012 Nov 27.

Abstract

BACKGROUND

A trough concentration of >20 mg/L is considered the optimal dosage of teicoplanin required to ensure early therapeutic effects against methicillin-resistant Staphylococcus aureus (MRSA) infections including those in patients who develop febrile neutropenia after chemotherapy. This study determines appropriate initial doses during the first 2 days of administration and evaluates the therapeutic target teicoplanin trough concentration.

METHOD

A 2-day regimen was evaluated in patients treated with 600 mg and 1200 mg or 1200 mg and 600 mg (total 1800 mg, Group 1), 800 mg and 800 mg (total 1600 mg, Group 2), and 800 mg and 400 mg (total 1200 mg, Group 3) of teicoplanin on Days 1 and 2, respectively. We also compared the efficiency and adverse effects at trough concentrations of 15-20 mg/L (Group A, n = 28) with >20 mg/L (Group B, n = 27) of teicoplanin, and also compared them with those on the similar concentrations of vancomycin (Groups C and D, n = 50 and 34, respectively).

RESULTS

The mean trough concentrations of teicoplanin on Days 4 or 5 were 22.2, 17.5, and 16.2 mg/L in Groups 1, 2, and 3, respectively. The clinical efficiency was 85.7%, 81.5%, 92.0%, and 91.5%, in Groups A, B, C, and D, respectively. The rates of adverse effects were not high in teicoplanin (nephrotoxicity, 7.1% and 3.7%, and hepatotoxicity, 14.3% and 11.1% in Groups A and B, respectively). However, more adverse effects tended to arise in patients who received vancomycin in nephrotoxicity (14.0% and 11.8%, in Groups C and D, respectively).

CONCLUSION

These results suggest that the 2-day regimens with total 1800 mg achieved the most effective therapeutic trough plasma concentration of teicoplanin (20 mg/L). However, 15-20 mg/L might also be an effective trough target for initial teicoplanin treatment. These teicoplanin regimens might be safer in terms of renal function than vancomycin.

摘要

背景

替考拉宁谷浓度>20mg/L被认为是确保对耐甲氧西林金黄色葡萄球菌(MRSA)感染(包括化疗后发生发热性中性粒细胞减少症的患者)产生早期治疗效果所需的最佳剂量。本研究确定给药前两天的合适初始剂量,并评估治疗目标替考拉宁谷浓度。

方法

对分别在第1天和第2天接受600mg和1200mg或1200mg和600mg(共1800mg,第1组)、800mg和800mg(共1600mg,第2组)以及800mg和400mg(共1200mg,第3组)替考拉宁治疗的患者进行为期2天的治疗方案评估。我们还比较了替考拉宁谷浓度为15 - 20mg/L(A组,n = 28)与>20mg/L(B组,n = 27)时的疗效和不良反应,并且将它们与万古霉素相似浓度时的疗效和不良反应进行比较(C组和D组,分别为n = 50和34)。

结果

第1、2、3组替考拉宁在第4天或第5天的平均谷浓度分别为22.2mg/L、17.5mg/L和16.2mg/L。A、B、C、D组的临床有效率分别为85.7%、81.5%、92.0%和91.5%。替考拉宁的不良反应发生率不高(A组和B组的肾毒性分别为7.1%和3.7%,肝毒性分别为14.3%和11.1%)。然而,接受万古霉素治疗的患者在肾毒性方面更容易出现更多不良反应(C组和D组分别为14.0%和11.8%)。

结论

这些结果表明,总计1800mg的2天治疗方案能使替考拉宁达到最有效的治疗谷血药浓度(20mg/L)。然而,15 - 20mg/L也可能是替考拉宁初始治疗的有效谷浓度目标。就肾功能而言,这些替考拉宁治疗方案可能比万古霉素更安全。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c2e8/3516451/4ccc1cc779a1/cpaa-4-071f1.jpg

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