万古霉素在MRSA老年下呼吸道感染患者体内的药代动力学研究

目的比较万古霉素在甲氧西林耐药金黄色葡萄球菌(MRSA)老年下呼吸道感染患者和健康年轻人体内的药代动力学,为MRSA老年下呼吸道感染患者合理用药提供依据。方法给15例MRSA下呼吸道感染患者(感染组)和15例健康年轻受试者(健康组)分别静脉滴注1.0g万古霉素,通过荧光偏振免疫法(FPIA)测定血清中万古霉素的浓度,计算其药代动力学参数。结果与健康组比较,感染组的消除半衰期(t1/2β)(10.86±2.12h)明显延长(p<0.01),表观分布容积(Vd)增大(p<0.01),药时曲线下面积(AUC)增加(p<0.01),肌酐清除率(Ccr)下降(p<0.01),两组血药峰浓度(Cmax)无明显差异(p>0.05)。结论MRSA下呼吸道感染老年患者在应用万古霉素时,应当监测血药浓度,适当减少剂量或延长给药间隔,作到个体化用药。

THE PHARMACOKINETICS OF VANCOMYCIN IN THE ELDERLY PATIENTS WITH MRSA INFECTED LOWER RESPIRATORY TRACT

Objective To provide rational use of vancomycin in elderly MRSA-infected patients, compared its pharmacokinetics in the elderly MRSA-infected patients with healthy young subjects.Methods 15 elderly MRSA-infected patients and 15 healthy young subjects were injected with 1.0g vancomycin.Serum concentrations were determined by fluorescence polarization immunoassay(FPIA) in both groups(n infected=15,n healthy =15),then calculated the pharmacokinetic parameters with program 3p97.Results Compared with the healthy group, the elimination half life (t1/2β)were longer, the apparent volume of distribution (Vd)and the area under curve(AUC)were increased,the creatinine clearance(Ccr)were lower in the infected group.The differences of these pharmacokinetic parameters between the two groups were statistically significant(p<0.01) except the peak serum concentrations(p>0.05).Conclusion Vancomycin should be used with decreased dose or increased interval in the elderly MRSA-infected patients, therapeutic drug monitoring and personalized medicine were required.