Rybak Michael J, Le Jennifer, Lodise Thomas P, Levine Donald P, Bradley John S, Liu Catherine, Mueller Bruce A, Pai Manjunath P, Wong-Beringer Annie, Rotschafer John C, Rodvold Keith A, Maples Holly D, Lomaestro Benjamin
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
School of Medicine, Wayne State University, Detroit, Michigan, USA.
Clin Infect Dis. 2020 Sep 12;71(6):1361-1364. doi: 10.1093/cid/ciaa303.
Recent clinical data on vancomycin pharmacokinetics and pharmacodynamics suggest a reevaluation of current dosing and monitoring recommendations. The previous 2009 vancomycin consensus guidelines recommend trough monitoring as a surrogate marker for the target area under the curve over 24 hours to minimum inhibitory concentration (AUC/MIC). However, recent data suggest that trough monitoring is associated with higher nephrotoxicity. This document is an executive summary of the new vancomycin consensus guidelines for vancomycin dosing and monitoring. It was developed by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee. These consensus guidelines recommend an AUC/MIC ratio of 400-600 mg*hour/L (assuming a broth microdilution MIC of 1 mg/L) to achieve clinical efficacy and ensure safety for patients being treated for serious methicillin-resistant Staphylococcus aureus infections.
近期有关万古霉素药代动力学和药效学的临床数据表明，需要重新评估当前的给药剂量和监测建议。2009年之前的万古霉素共识指南推荐监测谷浓度，以此作为24小时曲线下面积与最低抑菌浓度（AUC/MIC）目标值的替代指标。然而，近期数据表明，监测谷浓度与更高的肾毒性相关。本文档是关于万古霉素给药剂量和监测的新共识指南的执行摘要。它由美国卫生系统药师协会、美国传染病学会、儿科传染病学会以及传染病药师学会万古霉素共识指南委员会共同制定。这些共识指南推荐，对于正在接受治疗的严重耐甲氧西林金黄色葡萄球菌感染患者，为实现临床疗效并确保安全，AUC/MIC比值应为400 - 600 mg·小时/L（假设肉汤微量稀释法测得的MIC为1 mg/L）。
