万古霉素曲线下面积指导剂量和监测成人和儿童疑似或确诊严重耐甲氧西林金黄色葡萄球菌感染患者：把我们患者的安全放在首位。
Vancomycin Area Under the Curve-Guided Dosing and Monitoring for Adult and Pediatric Patients With Suspected or Documented Serious Methicillin-Resistant Staphylococcus aureus Infections: Putting the Safety of Our Patients First.
机构信息
Albany College of Pharmacy and Health Sciences, Albany, New York, USA.
Institute for Therapeutic Innovation, University of Florida, Orlando, Florida, USA.
出版信息
Clin Infect Dis. 2021 May 4;72(9):1497-1501. doi: 10.1093/cid/ciaa1744.
The revised vancomycin consensus guidelines recommended area under the curve (AUC)-guided dosing/monitoring for patients with serious invasive methicillin-resistant Staphylococcus aureus (MRSA) infections as a measure to minimize vancomycin-associated acute kidney injury (VA-AKI) while maintaining similar effectiveness. Data indicate that the intensity of vancomycin exposure drives VA-AKI risk. Troughs of 15-20 mg/L will ensure an AUC ≥400 mg × hr/L but most patients will have daily AUCs >600. VA-AKI increases as a function of AUC, especially when >600. In addition to minimizing VA-AKI risk while maintaining similar efficacy, AUC-guided dosing/monitoring is a more precise way to conduct therapeutic drug monitoring for vancomycin relative to trough-only control.
修订后的万古霉素共识指南建议对患有严重侵袭性耐甲氧西林金黄色葡萄球菌（MRSA）感染的患者进行基于曲线下面积（AUC）的给药/监测，以最大限度地减少万古霉素相关性急性肾损伤（VA-AKI），同时保持相似的疗效。数据表明，万古霉素暴露的强度会增加 VA-AKI 的风险。15-20mg/L 的谷浓度将确保 AUC≥400mg×hr/L，但大多数患者的每日 AUC 会>600。VA-AKI 随着 AUC 的增加而增加，尤其是当 AUC>600 时。AUC 指导的给药/监测不仅可以降低 VA-AKI 的风险，同时还能保持相似的疗效，相对于仅监测谷浓度，它是一种更精确的万古霉素治疗药物监测方法。
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