Mejías-Trueba Marta, Alonso-Moreno Marta, Herrera-Hidalgo Laura, Gil-Navarro Maria Victoria
Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain.
Unidad de Gestión Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, Spain.
Antibiotics (Basel). 2021 Mar 25;10(4):347. doi: 10.3390/antibiotics10040347.
Vancomycin is commonly used as a treatment for neonatal infections. However, there is a lack of consensus establishing the optimal vancomycin therapeutic regimen and defining the most appropriate PK/PD parameter correlated with the efficacy. A recent guideline recommends AUC-guided therapeutic dosing in treating serious infections in neonates. However, in clinical practice, trough serum concentrations are commonly used as a surrogate PKPD index for AUC24. Despite this, target serum concentrations in a neonatal population remain poorly defined. The objective is to describe the relationship between therapeutic regimens and the achievement of clinical or pharmacokinetic outcomes in the neonatal population. The review was carried out following PRISMA guidelines. A bibliographic search was manually performed for studies published on PubMed and EMBASE. Clinical efficacy and/or target attainment and the safety of vancomycin treatment were evaluated through obtaining serum concentrations. A total of 476 articles were identified, of which 20 met the inclusion criteria. All of them evaluated the target attainment, but only two assessed the clinical efficacy. The enormous variability concerning target serum concentrations is noteworthy, which translates into a difficulty in determining which therapeutic regimen achieves the best results. Moreover, there are few studies that analyze clinical efficacy results obtained after reaching predefined trough serum concentrations, this information being essential for clinical practice.
万古霉素常用于治疗新生儿感染。然而，对于确定最佳万古霉素治疗方案以及明确与疗效相关的最合适的药代动力学/药效学（PK/PD）参数，目前尚无共识。最近的一项指南建议在治疗新生儿严重感染时采用AUC指导的治疗剂量。然而，在临床实践中，血清谷浓度通常被用作AUC24的替代PKPD指标。尽管如此，新生儿群体的目标血清浓度仍未明确界定。目的是描述新生儿群体中治疗方案与临床或药代动力学结果达成之间的关系。本综述按照PRISMA指南进行。通过在PubMed和EMBASE上手动检索已发表的研究。通过获取血清浓度来评估万古霉素治疗的临床疗效和/或目标达成情况以及安全性。共识别出476篇文章，其中20篇符合纳入标准。所有研究都评估了目标达成情况，但只有两项评估了临床疗效。值得注意的是，目标血清浓度存在巨大差异，这导致难以确定哪种治疗方案能取得最佳效果。此外，很少有研究分析在达到预定义的血清谷浓度后获得的临床疗效结果，而这些信息对临床实践至关重要。
