Department of Pharmaceutical Services, Emory University Hospital, Atlanta, GA, USA.
Ann Pharmacother. 2013 Mar;47(3):e14. doi: 10.1345/aph.1Q488. Epub 2013 Feb 12.
To report the pharmacokinetic and pharmacodynamic properties of vancomycin in 4 patients undergoing high-volume continuous venovenous hemofiltration (CVVH).
Data from 4 patients prescribed high-volume CVVH for acute renal failure treated with vancomycin were analyzed. Vancomycin plasma concentrations were measured 4 and 24 hours after the end of a 1-hour vancomycin infusion. The mean therapy fluid rate on initiation of vancomycin was 56.2 mL/kg/h (range 48.0-65.5). The mean loading dose of vancomycin was 18.3 mg/kg (range 14.7-19.7). Median vancomycin concentration 4 hours after the dose was 18.1 mg/L (range 13.1-30.0). At 24 hours after the dose, only 1 patient had a detectable vancomycin concentration (5.2 mg/L).
There was a large variability in the clearance of vancomycin in this patient population. Current strategies for dosing vancomycin may lead to subtherapeutic trough concentrations. Vancomycin dosing in this patient population should be based on a detailed assessment of the CVVH prescription, vancomycin concentrations, and clinical needs and response.
An initial vancomycin dose of 20-25 mg/kg with frequent monitoring and adjustment is recommended for patients receiving high-volume CVVH.
报告 4 例接受高容量连续性静脉-静脉血液滤过（CVVH）治疗的患者中万古霉素的药代动力学和药效学特性。
分析了 4 例因急性肾衰竭接受高容量 CVVH 治疗并接受万古霉素治疗的患者的数据。在万古霉素输注结束后 4 小时和 24 小时测量了万古霉素的血浆浓度。开始使用万古霉素时的平均治疗液率为 56.2 mL/kg/h（范围 48.0-65.5）。万古霉素的平均负荷剂量为 18.3 mg/kg（范围 14.7-19.7）。剂量后 4 小时的中位数万古霉素浓度为 18.1 mg/L（范围 13.1-30.0）。剂量后 24 小时，只有 1 例患者有可检测到的万古霉素浓度（5.2 mg/L）。
在该患者人群中，万古霉素的清除率存在很大差异。目前万古霉素的剂量策略可能导致谷浓度低于治疗范围。在该患者人群中，应根据 CVVH 处方、万古霉素浓度以及临床需求和反应来评估万古霉素的剂量。
建议接受高容量 CVVH 的患者初始万古霉素剂量为 20-25 mg/kg，并进行频繁监测和调整。
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