Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina, Gaslini, Genova, Italy.
UOC Servizio di Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genova, Italy.
Clin Biochem. 2024 Mar;125:110728. doi: 10.1016/j.clinbiochem.2024.110728. Epub 2024 Feb 5.
Vancomycin is a glycopeptide antibiotic that has been adopted in clinical practice to treat gram-positive infections for more than 70 years. Despite vancomycin's long history of therapeutic use, optimal dose adjustments and pharmacokinetic/pharmacodynamic (PK/PD) target attainment in children are still under debate. Therapeutic drug monitoring (TDM) has been widely integrated into pediatric clinical practice to maximize efficacy and safety of vancomycin treatment. Area under the curve (AUC)-guided TDM has been recently recommended instead of trough-only TDM to ensure PK/PD target attainment of AUC/minimal inhibitory concentration (MIC) > 400 to 600 and minimize acute kidney injury risk. Bayesian forecasting in pediatric patients allows estimation of population PK to accurately predict individual vancomycin concentrations over time, and consequently total vancomycin exposure. AUC-guided TDM for vancomycin, preferably with Bayesian forecasting, is therefore suggested for all pediatric age groups and special pediatric populations. In this review we aim to analyze the current literature on the pediatric use of vancomycin and summarize the current knowledge on dosing optimization for target attainment in special patient populations.
万古霉素是一种糖肽类抗生素，在临床实践中已被用于治疗革兰氏阳性感染超过 70 年。尽管万古霉素的治疗应用历史悠久，但在儿童中，最佳剂量调整和药代动力学/药效学（PK/PD）目标的实现仍存在争议。治疗药物监测（TDM）已广泛整合到儿科临床实践中，以最大程度地提高万古霉素治疗的疗效和安全性。最近建议采用 AUC 指导的 TDM 替代仅谷浓度 TDM，以确保 AUC/最小抑菌浓度（MIC）>400 至 600 的 PK/PD 目标实现，并降低急性肾损伤风险。儿科患者的贝叶斯预测允许对人群 PK 进行估计，从而准确预测个体万古霉素浓度随时间的变化，进而预测总万古霉素暴露量。因此，建议对所有儿科年龄组和特殊儿科人群进行 AUC 指导的万古霉素 TDM，最好结合贝叶斯预测。在这篇综述中，我们旨在分析关于儿童使用万古霉素的现有文献，并总结关于在特殊患者群体中实现目标的剂量优化的现有知识。
