推荐负荷剂量后替考拉宁谷值在儿童中的评估及相关安全性分析
Evaluation of Teicoplanin Trough Values After the Recommended Loading Dose in Children With Associated Safety Analysis.
作者信息
Yamada Takaaki, Kubota Toshio, Yonezawa Mahoro, Nishio Hisanori, Kanno Shunsuke, Yano Takahisa, Kobayashi Daisuke, Egashira Nobuaki, Takada Hidetoshi, Hara Toshiro, Masuda Satohiro
机构信息
From the *Department of Pharmacy, Kyushu University Hospital, †Department of Clinical Pharmacy and Pharmaceutical care, Graduate School of Pharmaceutical Sciences, Kyushu University, and ‡Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
出版信息
Pediatr Infect Dis J. 2017 Apr;36(4):398-400. doi: 10.1097/INF.0000000000001456.
BACKGROUND
This study evaluated whether the recommended teicoplanin loading dose (3 loading doses of 10 mg/kg every 12 hours) achieves a 15-30 μg/mL trough levels in 26 children (2-16 years). In addition, we examined the incidences of renal impairment and hepatic dysfunction in children treated with teicoplanin.
METHODS
This retrospective study was conducted between October 2008 and March 2014.
RESULTS
The percentage of patients with a trough level <10 and <15 μg/mL were 15.4% (4/26) and 46.2% (12/26), respectively. There were significant correlations between age and concentration/cumulative loading dose (C/D) ratio (P = 0.045), serum creatinine and C/D ratio (P < 0.001) and estimated glomerular filtration rate and C/D ratio (P = 0.005). Serum creatinine was significantly lower when trough levels were <15 μg/mL compared with ≥15 μg/mL. The incidences of renal impairment and hepatic dysfunction were 2.3% and 5.8%, respectively, with no significant difference between <20 and ≥20 μg/mL trough-level groups.
CONCLUSIONS
The recommended loading dose may be insufficient to achieve 15-30 μg/mL in children with normal renal function. In addition, the target trough level ≥20 μg/mL for deep-seated infections seems to be safe in children.
背景
本研究评估了推荐的替考拉宁负荷剂量（每12小时3次10mg/kg的负荷剂量）是否能使26名2至16岁儿童的谷浓度达到15 - 30μg/mL。此外，我们还研究了接受替考拉宁治疗的儿童中肾功能损害和肝功能障碍的发生率。
方法
本回顾性研究于2008年10月至2014年3月进行。
结果
谷浓度<10μg/mL和<15μg/mL的患者百分比分别为15.4%（4/26）和46.2%（12/26）。年龄与浓度/累积负荷剂量（C/D）比之间存在显著相关性（P = 0.045），血清肌酐与C/D比之间存在显著相关性（P < 0.001），估计肾小球滤过率与C/D比之间存在显著相关性（P = 0.005）。谷浓度<15μg/mL时的血清肌酐显著低于≥15μg/mL时。肾功能损害和肝功能障碍的发生率分别为2.3%和5.8%，谷浓度<20μg/mL组和≥20μg/mL组之间无显著差异。
结论
对于肾功能正常的儿童，推荐的负荷剂量可能不足以使谷浓度达到15 - 30μg/mL。此外，对于深部感染，目标谷浓度≥20μg/mL对儿童似乎是安全的。
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