College of Pharmacy, Wonkwang University, Iksan, Republic of Korea.
Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul, Republic of Korea.
Eur J Hosp Pharm. 2020 Mar;27(e1):e25-e29. doi: 10.1136/ejhpharm-2018-001720. Epub 2019 Feb 20.
This study aimed to characterise vancomycin pharmacokinetics in critically ill neonates undergoing extracorporeal membrane oxygenation.
In a retrospective analysis, the pharmacokinetics of vancomycin were determined in 25 full-term neonates receiving extracorporeal membrane oxygenation and compared with those of matched controls (n = 25) not receiving extracorporeal membrane oxygenation.
The half-life of vancomycin in the neonates undergoing extracorporeal membrane oxygenation was significantly prolonged compared with that in the controls (17.45 ± 11.01 hour vs 5.92 ± 2.70 hour, P<0.001). Clearance decreased significantly in the extracorporeal membrane oxygenation group relative to the control group (0.03 ± 0.02 L/kg/hr vs 0.08 ± 0.05 L/kg/hr, P<0.001). No significant difference was found in the volume of distribution between the two groups (0.63 ± 0.30 L/kg in the extracorporeal membrane oxygenation group vs 0.57 ± 0.14 L/kg/hr in control, P=0.596). Clearance values were significantly correlated with serum creatinine (r = - 0.528, P<0.001). In the subgroup analysis using patients with serum creatinine < 0.5 mg/dL, similar results were obtained including significantly prolonged half-life (11.52 ± 6.31 hour vs 5.44 ± 2.36 hour, P<0.001) and decreased clearance (0.05 ± 0.02 L/kg/hr vs 0.09 ± 0.05 L/kg/hr, P<0.001) in the extracorporeal membrane oxygenation group relative to the control group.
Vancomycin clearance decreased significantly in the neonates undergoing extracorporeal membrane oxygenation compared with the controls. Dosing adjustments of vancomycin and close therapeutic drug monitoring are required for the safe and effective management of neonates during extracorporeal membrane oxygenation.
本研究旨在描述行体外膜肺氧合的危重新生儿万古霉素的药代动力学特征。
在一项回顾性分析中，我们测定了 25 例接受体外膜肺氧合的足月新生儿万古霉素的药代动力学，并将其与未接受体外膜肺氧合的匹配对照（n=25）进行比较。
与对照组相比，行体外膜肺氧合的新生儿万古霉素半衰期明显延长（17.45±11.01 小时 vs 5.92±2.70 小时，P<0.001）。与对照组相比，体外膜肺氧合组清除率显著降低（0.03±0.02 L/kg/hr vs 0.08±0.05 L/kg/hr，P<0.001）。两组间分布容积无显著差异（体外膜肺氧合组 0.63±0.30 L/kg vs 对照组 0.57±0.14 L/kg，P=0.596）。清除率与血清肌酐显著相关（r=-0.528，P<0.001）。在使用血清肌酐<0.5 mg/dL 的患者的亚组分析中，得到了类似的结果，包括半衰期明显延长（11.52±6.31 小时 vs 5.44±2.36 小时，P<0.001）和清除率降低（0.05±0.02 L/kg/hr vs 0.09±0.05 L/kg/hr，P<0.001）。
与对照组相比，行体外膜肺氧合的新生儿万古霉素清除率显著降低。在体外膜肺氧合期间，需要调整万古霉素剂量并进行密切的治疗药物监测，以确保新生儿的安全有效治疗。
