Takechi Kenshi, Yanagawa Hiroaki, Zamami Yoshito, Ishizawa Keisuke, Tanaka Akihiro, Araki Hiroaki
Int J Clin Pharmacol Ther. 2017 Aug;55(8):672-677. doi: 10.5414/CP203009.
Because teicoplanin has a long serum half-life, a longer period of time is needed to achieve a steady-state concentration compared with vancomycin. The administration of an initial loading dose has been recommended to reach an effective teicoplanin serum concentration for the treatment of methicillin-resistant
We analyzed patients with MRSA infections who were treated with teicoplanin intravenously between January 2010 and July 2014. The effect of loading dose administration was evaluated in patients treated with 1,200 mg or 1,600 mg of teicoplanin, respectively.
Approximately 32% (31/97) of patients achieved the trough concentration target (≥ 15 µg/mL) on the 3 or 4 day. Multivariate analysis showed that loading doses and body surface area (BSA) were associated with trough concentration > 15 µg/mL on the 3 or 4 day. Moreover, patients treated with the 2-day loading dose (1,600 mg group: 800 mg/day on 2 days) promptly achieved a trough concentration > 15 µg/mL on the 3 or 4 day compared with those receiving a 1-day loading dose (1,200 mg group: 800 mg/day on only 1 day). The receiver operating characteristic curve showed that the optimal cut-off point of estimated glomerular filtration rate (eGFR) was 56 mL/min with 1-day loading dose to achieve a trough concentration target > 15 µg/mL.
CONCLUSION: These results suggested that patients with decreased renal function (eGFR < 56 mL/min) can safely achieve an optimal trough level with the 1-day loading dose. In patients with normal renal function (eGFR ≥ 56 mL/min), administration of a 2-day loading dose may be needed to rapidly achieve a trough concentration ≥ 15 µg/mL. .
由于替考拉宁的血清半衰期较长，与万古霉素相比，需要更长时间才能达到稳态浓度。已建议给予初始负荷剂量以达到有效替考拉宁血清浓度，用于治疗耐甲氧西林金黄色葡萄球菌（MRSA）。然而，关于影响替考拉宁浓度的因素知之甚少。本研究旨在回顾性确定哪些因素与达到最佳替考拉宁谷浓度相关。
我们分析了2010年1月至2014年7月期间接受静脉注射替考拉宁治疗的MRSA感染患者。分别评估给予1200mg或1600mg替考拉宁的患者中负荷剂量给药的效果。
约32%（31/97）的患者在第3或第4天达到谷浓度目标（≥15μg/mL）。多因素分析表明，负荷剂量和体表面积（BSA）与第3或第4天谷浓度>15μg/mL相关。此外，与接受1天负荷剂量（1200mg组：仅1天800mg/天）的患者相比，接受2天负荷剂量（1600mg组：2天800mg/天）治疗的患者在第3或第4天迅速达到谷浓度>15μg/mL。受试者工作特征曲线显示，对于1天负荷剂量，估计肾小球滤过率（eGFR）的最佳截断点为56mL/min，以达到谷浓度目标>15μg/mL。
这些结果表明，肾功能下降（eGFR<56mL/min）的患者使用1天负荷剂量可安全达到最佳谷浓度。在肾功能正常（eGFR≥56mL/min）的患者中，可能需要给予2天负荷剂量以迅速达到谷浓度≥15μg/mL。
