Pettit Rebecca S, Peters Stacy J, McDade Erin J, Kreilein Kaci, Patel Radha, Epps Kevin, Kittell Frederick, Duval Mariela A, Zobell Jeffery T
Riley Hospital for Children at Indiana University Health (RSP), Indianapolis, Indiana, Sanford Medical Center (SJP), Sioux Falls, South Dakota, Texas Children's Hospital (EJM), Houston, Texas, Butler University (KK, RP), Indianapolis, Indiana, St. Vincent's Hospital Riverside (KE), Jacksonville, Florida, University of Wisconsin Hospital (FK), Madison, Wisconsin, Children's Healthcare of Atlanta (MAD), Atlanta, Georgia, and Intermountain Primary Children's Hospital (JTZ), Salt Lake City, Utah.
J Pediatr Pharmacol Ther. 2017 Nov-Dec;22(6):406-411. doi: 10.5863/1551-6776-22.6.406.
Vancomycin is commonly used in patients with cystic fibrosis (CF) to treat acute pulmonary exacerbations, but few guidelines exist to help dose and monitor patients. The objective of this study was to assess vancomycin use and monitoring strategies at Cystic Fibrosis Foundation (CFF)-accredited centers in hopes of developing and implementing vancomycin dosing and monitoring standards.
An anonymous national cross-sectional survey of pharmacists affiliated with CFF-accredited pediatric and/or adult centers was performed by using Surveymonkey.com. The survey consisted of 3 sections: (1) CF Center Demographic Information (10 questions); 2) vancomycin use in pediatric CF patients (31 questions); and 3) vancomycin use in adult CF patients (29 questions); it was administered from March 9, 2015, to April 13, 2015.
The survey was completed by 31/69 (45%) pharmacists and 28 (90.3%) reported using vancomycin in the pediatric population. The most common initial starting dose for pediatric patients was 15 mg/kg/dose (57.1%) and every 6 hours was the most common dosing frequency (67.9%). The most common monitoring strategy was collection of a trough concentration (92.9%) with 57.7% of pharmacist targeting a range of 15 to 20 mg/L. The most common initial starting vancomycin dose in adults with CF was 15 mg/kg/dose (61.5%), and initial frequency of every 8 hours (73.1%). The most common monitoring strategy was a trough concentration (96.2%) with 83.3% of pharmacists reporting a goal trough range of 15 to 20 mg/L.
The most common vancomycin dosing reported was 15 to 20 mg/kg/dose every 6 hours (pediatric) and 15 to 20 mg/kg/dose every 8 to 12 hours (adults). Serum concentrations measured to meet monitoring parameters of trough concentrations of 15 to 20 mg/L, or area under the curve to minimum inhibitory concentration ratio > 400, were the same in both pediatric and adult patients.
万古霉素常用于囊性纤维化（CF）患者以治疗急性肺部加重期，但几乎没有指南来指导用药剂量及监测。本研究的目的是评估囊性纤维化基金会（CFF）认可的中心使用万古霉素及监测策略的情况，以期制定并实施万古霉素给药及监测标准。
通过Surveymonkey.com对CFF认可的儿科和/或成人中心的药剂师进行了一项匿名的全国横断面调查。该调查包括3个部分：（1）CF中心人口统计学信息（10个问题）；（2）儿科CF患者使用万古霉素情况（31个问题）；（3）成人CF患者使用万古霉素情况（29个问题）；调查于2015年3月9日至2015年4月13日进行。
69名药剂师中有31名（45%）完成了调查，28名（90.3%）报告在儿科患者中使用万古霉素。儿科患者最常见的初始起始剂量是15mg/kg/次（57.1%），最常见的给药频率是每6小时一次（67.9%）。最常见的监测策略是采集谷浓度（92.9%），57.7%的药剂师将目标范围设定为15至20mg/L。CF成人患者最常见的初始万古霉素起始剂量是15mg/kg/次（61.5%），初始频率是每8小时一次（73.1%）。最常见的监测策略是谷浓度（96.2%），83.3%的药剂师报告目标谷浓度范围为15至20mg/L。
报告的最常见万古霉素给药方案是儿科每6小时15至20mg/kg/次，成人每8至12小时15至20mg/kg/次。在儿科和成人患者中，为达到谷浓度15至20mg/L的监测参数或曲线下面积与最低抑菌浓度比值>400而测量的血清浓度是相同的。
