Batchelder Nathan, Lutheran Carrie Faith, Frens Jeremy
Department of Pharmacy, Moses H. Cone Memorial Hospital, 1121 N. Church Street, Greensboro, NC, 27401, USA.
Fred Wilson School of Pharmacy, High Point University, One University Parkway, High Point, NC, 27268, USA.
Eur J Clin Pharmacol. 2020 Mar;76(3):403-408. doi: 10.1007/s00228-019-02811-0. Epub 2019 Dec 13.
The purpose of this study was to compare therapeutic vancomycin trough levels in obese adults when using an original nomogram (phase I) versus a modified nomogram (phase II).
This study compared a vancomycin nomogram with a modified vancomycin nomogram for obese adults over 100 kg. The primary endpoint compared the percentage of sub-therapeutic, therapeutic, and supra-therapeutic vancomycin trough concentrations between the nomograms. Patients were included if they were at least 18 years of age, had a total body weight of 100-299 kg, and had an initial vancomycin trough level collected. Patients were excluded if they had end-stage renal disease or were on continuous renal replacement therapy.
Therapeutic trough levels occurred in 85 out of 171 patients (50%) in phase I and 98 out of 149 patients (66%) in phase II. The incidence of both sub-therapeutic and supra-therapeutic troughs was less in phase II (p = 0.013). In the subgroup of adults aged 18 to 49 with a normalized creatinine clearance of greater than 90 mL/min, there was a trend in more therapeutic levels with the modified nomogram and less chance of sub-therapeutic levels (p = 0.088). In the subgroup of adults with a normalized creatinine clearance of 60-90 mL/min, there was significant improvement in therapeutic levels and a decrease in supra-therapeutic levels without increasing the percent of sub-therapeutic levels (p = 0.001).
The modified vancomycin nomogram at Cone Health showed significant improvement in therapeutic trough concentrations while reducing the rates of under and over dosing obese adults. The Cone Health-modified vancomycin nomogram could be a useful tool for initial dosing of vancomycin in the obese population.
本研究旨在比较肥胖成年人使用原始列线图（第一阶段）与改良列线图（第二阶段）时万古霉素的治疗谷浓度。
本研究比较了针对体重超过100千克的肥胖成年人的万古霉素列线图与改良万古霉素列线图。主要终点是比较列线图之间亚治疗、治疗和超治疗万古霉素谷浓度的百分比。纳入标准为年龄至少18岁、总体重100 - 299千克且收集了初始万古霉素谷浓度的患者。若患者患有终末期肾病或接受持续肾脏替代治疗，则予以排除。
第一阶段171例患者中有85例（50%）出现治疗性谷浓度，第二阶段149例患者中有98例（66%）出现治疗性谷浓度。第二阶段亚治疗性和超治疗性谷浓度的发生率均较低（p = 0.013）。在肌酐清除率正常且大于90 mL/min的18至49岁成年亚组中，改良列线图显示出更多治疗性浓度的趋势，且亚治疗性浓度的可能性较小（p = 0.088）。在肌酐清除率正常为60 - 90 mL/min的成年亚组中，治疗性浓度有显著改善，超治疗性浓度降低，且未增加亚治疗性浓度的百分比（p = 0.001）。
Cone Health的改良万古霉素列线图在治疗谷浓度方面有显著改善，同时降低了肥胖成年人用药不足和用药过量的发生率。Cone Health改良的万古霉素列线图可能是肥胖人群万古霉素初始给药的有用工具。
