Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Eur J Clin Microbiol Infect Dis. 2019 Nov;38(11):2113-2120. doi: 10.1007/s10096-019-03652-6. Epub 2019 Aug 1.
Therapeutic drug monitoring (TDM) of teicoplanin is aimed at minimizing the clinical impact of pharmacokinetic variability; however, its benefits are still being defined. We performed a retrospective study of teicoplanin TDM focusing on the dose-serum concentration relationship and clinical outcomes in a clinical setting. From January 2017 to December 2018, patients receiving teicoplanin ≥ 72 h with TDM were enrolled. Patients were divided into three groups: non-loading (NL) group, low-dose loading (LD) group (loading dose < 9 mg/kg), and high-dose loading (HD) group (≥ 9 mg/kg). Serum teicoplanin trough concentration (C) and adverse events (AEs) were evaluated in each regimen. A subgroup of patients with bacteremia was analyzed to evaluate clinical efficacy. Among 65 patients, 12, 18, and 35 were grouped in NL, LD, and HD, respectively. Achievement rates of C > 20 mg/L within 10 days were significantly different among the groups (25.0%, 38.9%, and 68.6% in the NL, LD, and HD groups, respectively; P = 0.014). Fourteen patients (21.5%) had AEs, and higher C over 10 days (adjusted odds ratio 2.08 per every 20 mg/L increases, 95% CI 1.13-3.84, P = 0.019) and age ≥ 65 years (P = 0.009) were identified as independent risk factors. In the subgroup analysis, HD regimen (P = 0.050) and high mean C over 10 days (P = 0.025) were significantly associated with treatment success. Although HL regimen could achieve C targets and improve clinical outcome during teicoplanin treatment, high C was associated with AEs during treatment. Routine TDM can be helpful to optimize teicoplanin administration.
替考拉宁的治疗药物监测（TDM）旨在最大程度地减少药代动力学变异性对临床的影响；然而，其益处仍在确定中。我们在临床环境中进行了一项关于替考拉宁 TDM 的回顾性研究，重点关注剂量-血清浓度关系和临床结局。从 2017 年 1 月至 2018 年 12 月，我们招募了接受替考拉宁治疗≥72 小时且进行 TDM 的患者。患者被分为三组：非负荷剂量（NL）组、低剂量负荷（LD）组（负荷剂量<9mg/kg）和高剂量负荷（HD）组（≥9mg/kg）。在每种方案中，评估了血清替考拉宁谷浓度（C）和不良事件（AE）。对患有菌血症的患者亚组进行分析，以评估临床疗效。在 65 名患者中，12 名、18 名和 35 名分别归入 NL、LD 和 HD 组。在 10 天内 C>20mg/L 的达标率在各组之间存在显著差异（NL、LD 和 HD 组分别为 25.0%、38.9%和 68.6%；P=0.014）。14 名患者（21.5%）发生 AE，10 天内 C 升高超过 10mg/L（调整优势比为每升高 20mg/L 增加 2.08，95%CI 为 1.13-3.84，P=0.019）和年龄≥65 岁（P=0.009）被确定为独立危险因素。在亚组分析中，HD 方案（P=0.050）和 10 天内平均 C 较高（P=0.025）与治疗成功显著相关。尽管 HD 方案可达到 C 目标并改善替考拉宁治疗期间的临床结局，但高 C 与治疗期间的 AE 相关。常规 TDM 有助于优化替考拉宁的给药。
