万古霉素在成人处方中的应用：在英国，是否是时候不再基于谷浓度来调整剂量了？
Vancomycin in adult prescribing: is it time to move on from trough-based dosing in the UK?
机构信息
Microbiology Department, Queens Medical Centre, Nottingham University Hospitals Trust, Derby Road, Nottingham NG7 2UH, UK.
Intensive Care Department, Lincoln Hospital, United Lincolnshire Hospitals Trust, Greetwell Road, Lincoln LN2 5QY, UK.
出版信息
J Antimicrob Chemother. 2021 Nov 12;76(12):3071-3072. doi: 10.1093/jac/dkab274.
Vancomycin remains a useful agent in the infection doctor's toolkit, particularly for Staphylococcus aureus and MRSA infections. Therapeutic drug monitoring (TDM) is essential to maintain efficacy and avoid toxicity. Until recently, trough-based dosing has been the recommended method but in recent years the reliability of this has been questioned. The 2020 Infectious Diseases Society of America (IDSA) vancomycin guideline update has sent a clear message that trough-based dosing is not to be relied on, instead recommending dosing via 24 h AUC/MIC. The UK, however, has yet to follow suit in this, despite the wealth of evidence showing that trough-based dosing puts patients at higher risk of nephrotoxicity. Clearly, it is time to incorporate AUC/MIC-based dosing to utilize this effective antibiotic safely.
万古霉素仍然是感染科医生工具包中的一种有用药物，特别是针对金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌感染。治疗药物监测（TDM）对于维持疗效和避免毒性至关重要。直到最近，基于谷浓度的给药方法一直是推荐的方法，但近年来，这种方法的可靠性受到了质疑。2020 年传染病学会（IDSA）万古霉素指南更新明确表明，不能依赖于基于谷浓度的给药方法，而应通过 24 小时 AUC/MIC 来进行给药。然而，英国尚未效仿这一做法，尽管有大量证据表明，基于谷浓度的给药方法会使患者面临更高的肾毒性风险。显然，现在是时候采用 AUC/MIC 为基础的给药方法来安全地使用这种有效的抗生素了。
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