Foote E F, Dreitlein W B, Steward C A, Kapoian T, Walker J A, Sherman R A
Department of Pharmacy Practice and Administration, College of Pharmacy, Rutgers, The State University of New Jersey, Piscataway 08855-0789, USA.
Clin Nephrol. 1998 Jul;50(1):51-5.
This study was undertaken to evaluate the pharmacokinetics of relatively high-dose vancomycin when administered during high-flux hemodialysis using a polysulfone membrane (F-80, Fresenius). Five noninfected, anuric patients received a single dose of 25 mg/kg of vancomycin infused during hemodialysis at a rate of one gram per hour and timed such that the end of the infusion coincided with the end of dialysis. Blood samples were drawn during the infusion, up to six hours after the end of dialysis and then prior to the next three dialysis treatments. Spent dialysate was collected during the infusion. Samples were analyzed using the EMIT assay. The percent of vancomycin lost during the first dialysis session ranged from 39.1 to 55.1% (mean, 45.7+/-6.4). The concentration of vancomycin at 6 hours after hemodialysis ranged from 18.2 to 45.1 mg/L (mean, 29.6+/-10.0 mg/l). Dialysis clearance ranged from 96.1 to 158.1 ml/min (mean, 130.7 +/-30.0 ml/min). One week after dosing, serum concentrations ranged from 8.14 mg/l to 10.1 mg/l (mean, 9.0+/-1.0 mg/l). This study suggests than an initial dose of 25 mg/kg of vancomycin, given during high-flux dialysis, may provide adequate serum concentrations in anuric hemodialysis patients for up to seven days. This dosing scheme reduces inconvenience to the patient and staff, and potentially can reduce nursing costs associated with post-dialysis administration; its cost is minimal. At this point, subsequent dosing is best determined by therapeutic drug monitoring.
本研究旨在评估使用聚砜膜（F - 80，费森尤斯）进行高通量血液透析时给予相对高剂量万古霉素的药代动力学。五名未感染且无尿的患者在血液透析期间接受了单剂量25mg/kg的万古霉素静脉输注，输注速率为每小时1克，输注时间设定为输注结束与透析结束同时。在输注期间、透析结束后长达6小时以及随后三次透析治疗前采集血样。在输注期间收集用过的透析液。使用酶放大免疫测定技术（EMIT）分析样本。在第一次透析过程中万古霉素的丢失百分比范围为39.1%至55.1%（平均，45.7±6.4）。血液透析后6小时万古霉素浓度范围为18.2至45.1mg/L（平均，29.6±10.0mg/L）。透析清除率范围为96.1至158.1ml/分钟（平均，130.7±30.0ml/分钟）。给药一周后，血清浓度范围为8.14mg/L至10.1mg/L（平均，9.0±1.0mg/L）。本研究表明，在高通量透析期间给予初始剂量25mg/kg的万古霉素，可能在无尿血液透析患者中提供长达七天的足够血清浓度。这种给药方案减少了患者和工作人员的不便，并且有可能降低与透析后给药相关的护理成本；其成本最低。此时，后续给药最好通过治疗药物监测来确定。
