Cantú T G, Yamanaka-Yuen N A, Lietman P S
Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Clin Infect Dis. 1994 Apr;18(4):533-43.
Although monitoring serum vancomycin concentrations in clinical practice is commonplace, the data supporting this practice are meager. The rationale for monitoring these concentrations is to improve the effectiveness and/or reduce the toxicity of the drug. However, there are no data to suggest that monitoring serum vancomycin concentrations improves the effectiveness of therapy. In addition, despite many case reports of vancomycin-associated nephrotoxicity and ototoxicity, it is unclear whether this agent truly causes such conditions. Moreover, there is no evidence that adherence to specific ranges of vancomycin concentrations will preclude these events. Finally, vancomycin pharmacokinetics are sufficiently predictable that adequate serum drug concentrations can be obtained with dosing methods that take into account the patient's age, weight, and renal function. Safe and effective vancomycin dosage regimens can be constructed with these empirical dosing methods, whereas monitoring vancomycin levels increases the cost of therapy without improving the safety or efficacy of treatment.
尽管在临床实践中监测血清万古霉素浓度很常见，但支持这种做法的数据却很少。监测这些浓度的理论依据是提高药物的有效性和/或降低其毒性。然而，没有数据表明监测血清万古霉素浓度能提高治疗效果。此外，尽管有许多关于万古霉素相关肾毒性和耳毒性的病例报告，但尚不清楚这种药物是否真的会导致这些情况。而且，没有证据表明维持特定的万古霉素浓度范围就能避免这些事件。最后，万古霉素的药代动力学具有足够的可预测性，通过考虑患者年龄、体重和肾功能的给药方法可以获得足够的血清药物浓度。使用这些经验性给药方法可以构建安全有效的万古霉素给药方案，而监测万古霉素水平会增加治疗成本，却无法提高治疗的安全性或有效性。
