Lopez Natasha D, Griggs Michael, Sin Jonathan H, Roberts Russel J, Allegretti Andrew S
Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Pharmacy, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Pharmacotherapy. 2024 Jan;44(1):69-76. doi: 10.1002/phar.2885. Epub 2023 Oct 16.
Vancomycin pharmacokinetics are affected by renal replacement therapy and physiologic changes in critically ill patients. Literature regarding vancomycin removal and pharmacokinetics during accelerated venovenous hemofiltration (AVVH), a form of prolonged intermittent renal replacement therapy, is limited.
To describe the removal and pharmacokinetics of vancomycin during AVVH.
Eighteen critically ill adults receiving vancomycin and AVVH were included. Vancomycin serum concentrations were obtained within 4 h before and 2-6 h after the AVVH session. Patients' serum concentrations were plotted against time, and individual pharmacokinetic parameters were determined by a one-compartmental analysis. Continuous data are reported as a median (interquartile range [IQR]) and categorical data as a percentage.
The median AVVH effluent rate was 39.3 mL/kg/h (IQR 35.5-48 mL/kg/h) for a duration of 9 h (IQR 8-9.75 h). AVVH decreased vancomycin concentrations by 29.8% (IQR 24.9%-35.9%), at a rate of 3.4% per hour (IQR 3.1%-4.3% per hour) of AVVH. The vancomycin elimination rate constant and half-life were 0.039 h (IQR 0.036-0.053 h ) and 17.6 h (IQR 13.1-18.8 h), respectively. The area under the curve during AVVH was 171.7 mgh/L (IQR 149.1-190 mgh/L). The volume of distribution in 10 patients was 1 L/kg (IQR 0.73-1.1 L/kg). After AVVH, vancomycin 1000 mg (IQR 750-1000 mg) was needed to maintain a serum trough concentration ≥15 mg/L.
Vancomycin is significantly removed by AVVH, which requires supplemental dosing after completion of the AVVH session to maintain desired serum concentrations. Therapeutic drug monitoring of vancomycin serum concentrations is recommended for patients undergoing AVVH.
万古霉素的药代动力学受肾脏替代治疗及危重症患者生理变化的影响。关于加速持续静静脉血液滤过（AVVH，一种延长的间歇性肾脏替代治疗形式）过程中万古霉素清除率及药代动力学的文献有限。
描述AVVH期间万古霉素的清除率及药代动力学。
纳入18例接受万古霉素治疗及AVVH的成年危重症患者。在AVVH治疗前4小时内及治疗后2 - 6小时获取万古霉素血清浓度。将患者血清浓度随时间作图，并通过单室分析确定个体药代动力学参数。连续数据以中位数（四分位间距[IQR]）报告，分类数据以百分比报告。
AVVH的中位超滤率为39.3 mL/kg/h（IQR 35.5 - 48 mL/kg/h），持续时间为9小时（IQR 8 - 9.75小时）。AVVH使万古霉素浓度降低29.8%（IQR 24.9% - 35.9%），降低速率为每小时3.4%（IQR每小时3.1% - 4.3%）的AVVH治疗时间。万古霉素消除速率常数和半衰期分别为0.039小时（IQR 0.036 - 0.053小时）和17.6小时（IQR 13.1 - 18.8小时）。AVVH期间曲线下面积为171.7 mgh/L（IQR 149.1 - 190 mgh/L）。10例患者的分布容积为1 L/kg（IQR 0.73 - 1.1 L/kg）。AVVH治疗后，需要1000 mg（IQR 750 - 1000 mg）万古霉素以维持血清谷浓度≥15 mg/L。
AVVH可显著清除万古霉素，在AVVH治疗结束后需要补充给药以维持所需血清浓度。建议对接受AVVH的患者进行万古霉素血清浓度的治疗药物监测。
