Sato Yuhki, Hiramatsu Kazufumi, Suzuki Yosuke, Tanaka Ryota, Kaneko Tetsuya, Nonoshita Ko, Ogata Masao, Kadota Jun-Ichi, Itoh Hiroki
Department of Clinical Pharmacy, Oita University Hospital, Yufu, Japan.
Chemotherapy. 2018;63(1):29-34. doi: 10.1159/000481725. Epub 2017 Nov 24.
Teicoplanin is a glycopeptide antibiotic currently used for the treatment of methicillin-resistant Staphylococcus aureus. The need for therapeutic drug monitoring of teicoplanin has been increasingly highlighted as important. It is generally accepted that whereas a plasma trough concentration (Cmin) of ≥10 mg/L is appropriate for the majority of infections, it should exceed 20 mg/L for severe infections. The target Cmin of teicoplanin in patients with febrile neutropenia (FN) has not been reported. The aim of this study was to estimate the target Cmin for the treatment of FN in patients with hematological malignancy.
In this retrospective, single-center, observational cohort study, the records of 52 hospitalized patients with hematological malignancy who were treated with teicoplanin for FN due to bacteriologically documented or presumptive gram-positive infections were analyzed.
A significant difference in the first Cmin of teicoplanin was observed between the response and nonresponse groups in patients with bacteremia. The areas under the receiver operating characteristic curves were 0.80 for clinical efficacy. The cut-off value of teicoplanin Cmin on days 4-6 was 15.2 mg/L (sensitivity 80.0%, specificity 75.0%).
The authors propose a target teicoplanin Cmin of ≥15.2 mg/L for FN in patients with hematological malignancy.
替考拉宁是一种糖肽类抗生素，目前用于治疗耐甲氧西林金黄色葡萄球菌感染。对替考拉宁进行治疗药物监测的必要性日益凸显。普遍认为，大多数感染时血浆谷浓度（Cmin）≥10mg/L 是合适的，而严重感染时应超过 20mg/L。目前尚无关于发热性中性粒细胞减少症（FN）患者替考拉宁的目标 Cmin 的报道。本研究旨在评估血液系统恶性肿瘤患者 FN 治疗的替考拉宁目标 Cmin。
在这项回顾性、单中心、观察性队列研究中，分析了 52 例因细菌学证实或疑似革兰氏阳性感染而接受替考拉宁治疗 FN 的住院血液系统恶性肿瘤患者的记录。
菌血症患者中，替考拉宁首次 Cmin 在反应组和无反应组之间存在显著差异。临床疗效的受试者工作特征曲线下面积为 0.80。第 4 - 6 天替考拉宁 Cmin 的截断值为 15.2mg/L（敏感性 80.0%，特异性 75.0%）。
作者建议血液系统恶性肿瘤患者 FN 的替考拉宁目标 Cmin≥15.2mg/L。
