Bader Mazen S, Hawboldt John, Main Cheryl, Mertz Dominik, Loeb Mark, Farrell Alison, Joyce Joanna
Faculty of Health Sciences, Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Canada.
Hamilton Health Sciences, Juravinski Hospital and Cancer Centre, Hamilton, Canada.
Infect Dis (Lond). 2020 Nov-Dec;52(12):847-857. doi: 10.1080/23744235.2020.1800080. Epub 2020 Aug 3.
Guidelines recommend oral vancomycin as first-line therapy for infection. Guideline recommendations vary regarding dosing of vancomycin. Our aim was to summarize the current evidence on the efficacy and adverse effects of high dose oral and vancomycin retention enema (>500 mg/day) for the treatment of infection.
We searched clinical studies and major guidelines in the English language using MEDLINE, the Cochrane Library and Embase from 1985 until 15 April 2020.
No evidence supports the use of high dose oral vancomycin in the treatment of severe infection. Weak evidence from observational studies supports the use of high dose oral vancomycin in addition to intravenous metronidazole and high dose vancomycin retention enema in fulminant infection. Vancomycin retention enema can be used in severe infection when oral administration is not possible, or in conditions when the oral formulation cannot reach the colon such as Hartman's pouch, ileostomies, or colon diversions.
The dosing schedules for oral vancomycin and vancomycin enemas are not clearly defined due to widely varying results in clinical studies. Large, comparative multicenter trials are urgently needed to define the role of high dose vancomycin in infection.
指南推荐口服万古霉素作为[感染名称]感染的一线治疗药物。关于万古霉素的给药剂量，指南建议各不相同。我们的目的是总结目前关于高剂量口服万古霉素和万古霉素保留灌肠（>500mg/天）治疗[感染名称]感染的疗效和不良反应的证据。
我们使用MEDLINE、Cochrane图书馆和Embase从1985年至2020年4月15日检索了英文的临床研究和主要指南。
没有证据支持使用高剂量口服万古霉素治疗严重[感染名称]感染。观察性研究的薄弱证据支持在暴发性[感染名称]感染中，除静脉注射甲硝唑外，加用高剂量口服万古霉素和高剂量万古霉素保留灌肠。当无法口服给药，或在口服制剂无法到达结肠的情况下，如哈特曼袋、回肠造口术或结肠改道时，万古霉素保留灌肠可用于严重[感染名称]感染。
由于临床研究结果差异很大，口服万古霉素和万古霉素灌肠的给药方案尚未明确界定。迫切需要进行大规模、比较性的多中心试验来确定高剂量万古霉素在[感染名称]感染中的作用。
