Pawlotsky F, Thomas A, Kergueris M F, Debillon T, Roze J C
Unité de Réanimation Néonatologie, Hôpital Mère et Enfant, CHU Nantes, France.
Br J Clin Pharmacol. 1998 Aug;46(2):163-7. doi: 10.1046/j.1365-2125.1998.00763.x.
Since vancomycin's bactericidal action has been shown to be time-dependent, a constant rate infusion over 24 h might result in a better bactericidal efficacy. The purpose of this study was to define a new dosage schedule in prematures.
Two vancomycin 24 h constant rate infusion schedules were tested in two groups of neonates. Postconceptional age (PCA) was 27 to 41 weeks in group 1 (n=24) and 28 to 51.5 weeks in group 2 (n=29). Group 1 neonates received continuous infusion of 10 to 30 mgkg(-1) day(-1), adjusted for PCA and weight. Group 2 was designed to take into account the significant relationship observed in group 1 between vancomycin clearance standardized on weight and PCA and consisted of a constant loading dose of 7 mg kg(-1) followed by continuous infusion of 10 to 40 mg kg(-1) day(-1) adjusted for PCA and weight.
Mean vancomycin serum concentration at steady state was 11+/-3.1 mg1(-1) in group 1 and 15.4+/-6.2 mg1(-1) in group 2. Fifty-six percent of group 1 values vs 88% of group 2 values were between 10 and 30 mg at steady state (P<0.01). Both regimens were well tolerated.
A loading dose of vancomycin followed by constant rate infusion of the appropriate dose adjusted for PCA and weight might improve vancomycin concentrations in neonates.
由于已证明万古霉素的杀菌作用具有时间依赖性，24小时持续静脉滴注可能会产生更好的杀菌效果。本研究的目的是确定一种针对早产儿的新给药方案。
在两组新生儿中测试了两种万古霉素24小时持续静脉滴注方案。第1组（n = 24）的孕龄（PCA）为27至41周，第2组（n = 29）为28至51.5周。第1组新生儿接受10至30mgkg（-1）天（-1）的持续静脉滴注，并根据PCA和体重进行调整。第2组的设计考虑了在第1组中观察到的万古霉素清除率与体重和PCA之间的显著关系，包括7mg kg（-1）的恒定负荷剂量，随后是10至40mg kg（-1）天（-1）的持续静脉滴注，并根据PCA和体重进行调整。
第1组稳态时万古霉素的平均血清浓度为11±3.1mg1（-1），第2组为15.4±6.2mg1（-1）。稳态时第1组56%的值与第2组88%的值在10至30mg之间（P<0.01）。两种方案耐受性均良好。
先给予万古霉素负荷剂量，然后根据PCA和体重调整合适剂量进行持续静脉滴注，可能会提高新生儿体内的万古霉素浓度。
