Rajon Kevin, Vaillancourt Regis, Varughese Nisha, Villarreal Gilda
Pharmaceutical and Biological Sciences Institute, Faculty of Medicine and Pharmacy. University of Lyon. Lyon (France).
Department of Clinical Pharmacy, Children's Hospital of Eastern Ontario. Ontario, Ottawa (Canada).
Pharm Pract (Granada). 2017 Apr-Jun;15(2):887. doi: 10.18549/PharmPract.2017.02.887. Epub 2017 Jun 30.
Vancomycin is used primarily for Gram-positive infections. Recommended dosage regimens and targeted therapeutic levels vary between institutions.
This study aims to describe therapeutic levels according to initial vancomycin doses and patient's age. A secondary objective was to evaluate appropriateness of vancomycin use in our hospital.
A retrospective chart review was conducted at the Children's Hospital of Eastern Ontario. Patients included in this study were classified by age (neonates, infants, children and adolescents) and categorized into those who received vancomycin ≤5 and >5 days. Initial vancomycin dosing regimens and corresponding initial trough levels obtained were evaluated. Initial trough levels drawn in relation to the third, fourth, or fifth doses corresponding to the first course of therapy were analyzed. Acceptable trough levels ranged from 5-20 mg/L.
One-hundred-and-sixty-four patients who received intravenous vancomycin in 2013 were included. Of the 229 courses of vancomycin, 190 (83%) were used 5 days or less (mean 4.9 days). Sixteen infants (88.9%) and 21 adolescents (100%), who received vancomycin empiric dosing of 60 mg/kg/day, had initial trough levels >5mg/L. However, in the children's group 20 (37.7%) did not reach levels >5 mg/L. None of vancomycin minimum inhibitory concentration (MIC) values were >1mg/L for the four patients who had infections due to methicillin-resistant Staphylococcus aureus strains.
In our institution, initial empiric vancomycin dosing of 60 mg/kg/day resulted in levels ≥5mg/L in most infants and adolescents. It remains unclear why some children aged 1-12 years did not achieve these levels.
万古霉素主要用于革兰氏阳性菌感染。不同机构推荐的给药方案和目标治疗水平有所不同。
本研究旨在描述根据初始万古霉素剂量和患者年龄的治疗水平。次要目的是评估我院万古霉素使用的合理性。
在安大略东部儿童医院进行了一项回顾性病历审查。本研究纳入的患者按年龄（新生儿、婴儿、儿童和青少年）分类，并分为接受万古霉素治疗≤5天和>5天的患者。评估初始万古霉素给药方案和相应的初始谷浓度。分析与第一个疗程的第三、第四或第五剂相对应的初始谷浓度。可接受的谷浓度范围为5 - 20mg/L。
纳入了2013年接受静脉万古霉素治疗的164例患者。在229个万古霉素疗程中，190个（83%）使用时间为5天或更短（平均4.9天）。16例婴儿（88.9%）和21例青少年（100%）接受经验性万古霉素剂量60mg/kg/天，初始谷浓度>5mg/L。然而，在儿童组中，20例（37.7%）未达到>5mg/L的水平。对于4例因耐甲氧西林金黄色葡萄球菌菌株感染的患者，万古霉素的最低抑菌浓度（MIC）值均未>1mg/L。
在我们机构，初始经验性万古霉素剂量60mg/kg/天在大多数婴儿和青少年中导致谷浓度≥5mg/L。尚不清楚为什么一些1 - 12岁的儿童未达到这些水平。
