不同体重类别儿童万古霉素给药方案的前瞻性评估。
Prospective evaluation of the dosing regimen of vancomycin in children of different weight categories.
作者信息
Nassar Laila, Hadad Salim, Gefen Aharon, Shachor-Meyouhas Yael, Mashiach Tatiana, Krivoy Norberto, Kassis Imad
机构信息
Department of Pediatric Hematology Oncology, Meyer Children’s Hospital, Haifa, Israel.
出版信息
Curr Drug Saf. 2012 Nov 1;7(5):375-81. doi: 10.2174/157488612805076606.
BACKGROUND
Pharmacokinetics (PK), pharmacodynamics and optimal dosing of vancomycin in obese children is not known. Higher trough levels of vancomycin may improve outcomes. This prospective study evaluated the appropriateness of twice-daily regimen for the adherence to guidelines, among obese and non obese children.
METHODS
Children receiving vancomycin, (20 mg/kg BID) were included. Patients were divided into 3 groups. Adequacy was defined as trough level ≥ 10mg/L and AUC/MIC > 400. An alternative-dosing regimen was calculated based on individual PK parameters.
RESULTS
Seventy-seven pairs (trough, peak) were taken from 51 children. Mean trough level was 3.36 ± 2.58, only 3% fell in therapeutic range, no statistical difference was observed between obese, normal weight or underweight groups. One child had an AUC/MIC > 400. All children recovered.
CONCLUSION
PK properties of all weight groups were similar. More frequent and higher doses are needed to achieve the goals of current guidelines.
背景
肥胖儿童中万古霉素的药代动力学（PK）、药效学及最佳剂量尚不清楚。较高的万古霉素谷浓度可能改善治疗效果。本前瞻性研究评估了肥胖和非肥胖儿童每日两次给药方案对遵循指南情况的适宜性。
方法
纳入接受万古霉素治疗（20mg/kg，每日两次）的儿童。患者分为3组。充足性定义为谷浓度≥10mg/L且AUC/MIC>400。根据个体PK参数计算替代给药方案。
结果
从51名儿童中采集了77对（谷浓度、峰浓度）样本。平均谷浓度为3.36±2.58，只有3%处于治疗范围内，肥胖、正常体重或体重不足组之间未观察到统计学差异。1名儿童的AUC/MIC>400。所有儿童均康复。
结论
所有体重组的PK特性相似。需要更频繁和更高剂量才能达到当前指南的目标。
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