摘要
目的评价万古霉素常用的两个剂量在患儿治疗中的药效学和安全性,及其谷浓度的最佳水平,以期为临床更合理的使用和监测万古霉素提供参考。方法以2012年7月-2014年12月医院接受万古霉素40 mg/(kg·d)(低剂量组)或60mg/(kg·d)(高剂量组)且进行血药浓度监测的患儿作为研究对象,观察两组患儿的不良反应;通过群体药动学模型计算AUC0-24h;采用SPSS 18.0软件对数据进行统计分析。结果低、高剂量组平均AUC0-24h分别为(326.7±284.5)mg·h/L和(472.3±399.1)mg·h/L,差异有统计学意义(P<0.05);分别有21.7%和56.7%的患儿AUC0-24h>400mg·h/L;两组患儿的不良反应差异无统计学意义;谷浓度和AUC0-24h相关性良好(P<0.01),谷浓度为10mg/L时,所有患儿均可达到AUC0-24h>400mg·h/L。结论在患儿中,万古霉素60mg/(kg·d)的初始剂量较40 mg/(kg·d)能获得更好的临床效果,且不增加其不良反应,当MIC≤1mg/L,谷浓度为10mg/L时,即可达到AUC0-24h/MIC>400mg·h/L的治疗水平。
OBJECTIVE To evaluate the pharmacodynamics and safety of two commonly used dosages of vancomycin on treatment of children and determine the optimal trough concentration so as to provide guidance for reasonable clinical use and surveillance of vancomycin.METHODS The children who were treated with 40mg/（kg·d）of vancomycin（the low-dose group）or 60mg/（kg·d）of vancomycin（the high-dose group）and received the surveillance of blood concentrations from Jul 2012 to Dec 2014 were recruited as the study objects,then the adverse reactions in the children were observed,the AUC0-24 hwas calculated by means of population pharmacokinetics model,and the statistical analysis of data was performed with the use of SPSS18.0software.RESULTS The mean AUC0-24 h was（326.7±284.5）mg·h/L in the low-dose group,（472.3±399.1）mg·h/L in the high-dose group,and there was significant difference（P0.05）.The children with the AUC0-24 hmore than 400mg·h/L accounted for 21.7%in the low-dose group and accounted for 56.7%in the high-dose group.There was no significant difference in the incidence of adverse reactions between the two groups of children.The trough concentration was highly correlated with the AUC0-24 h,when the trough concentration was 10 mg/L,the AUC0-24 hwas more than 400mg·h/L for all the children.CONCLUSION As compared with the starting dose of 40mg/（kg·d）,the initial dose of vancomycin 60mg/（kg·d）can achieve more significant effect on treatment of the children without the increase of incidence of adverse reactions.When the MIC is no more than 1mg/L and the trough concentration is 10mg/L,the target AUC0-24h/MIC400mg·h/L can be achieved.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2016年第6期1393-1396,共4页
Chinese Journal of Nosocomiology
基金
湖北省卫生厅科研基金资助项目(JX5B74)
武汉市科技攻关基金资助项目(2013060602010258)
关键词
万古霉素
儿童
剂量
谷浓度
Vancomycin
Child
Dose
Trough concentration
