重症患者不同负荷剂量替考拉宁早期谷浓度的监测

目的了解给予不同负荷剂量替考拉宁的重症感染患者治疗3 d后的血清药物谷浓度(Cmin)及目标Cmin达标情况,旨在探讨理想的负荷剂量。方法选取2016年2月1日—2017年2月28日入住某院重症医学科重症感染患者,按不同药物负荷剂量(替考拉宁标准剂量6 mg/kg;高剂量10 mg/kg)和不同尿肌酐清除率(Ccr:以50 mL/min为标准线)水平分为4个亚组:标准剂量正常肌酐清除率组(G_(SD1)组)、标准剂量低肌酐清除率组(G_(SD2)组)、高剂量正常肌酐清除率组(G_(HD1)组)、高剂量低肌酐清除率组(G_(HD2)组),比较替考拉宁血清Cmin、目标Cmin达标情况以及不良反应情况。结果共入选患者49例,标准剂量组17例,其第4 d用药前Cmin为(5.98±2.67)mg/L;高剂量组32例,Cmin为(9.05±4.25)mg/L;高剂量组Cmin高于标准剂量组,差异有统计学意义(t=3.10,P=0.003)。G_(SD1)、G_(SD2)、G_(HD1)、G_(HD2)组Cmin分别为(5.78±2.72)、(6.34±2.78)、(8.21±3.77)、(12.07±4.81)mg/L,4组间Cmin比较,差异有统计学意义(F=4.766,P=0.006),G_(HD2)组高于G_(HD1)组、G_(SD2)组和G_(SD1)组;Cmin达标率分别为9.09%(1/11)、16.67%(1/6)、28.00%(7/25)、71.43%(5/7),差异有统计学意义(χ~2=8.766,P=0.033)。各组治疗期间均未发现明显药物相关性皮疹、肝肾功能损害。结论不论患者Ccr正常与否,给予标准负荷剂量的替考拉宁早期均不能达到目标Cmin;低Ccr者给予高负荷剂量替考拉宁早期可达目标Cmin;而正常Ccr者,则需进一步提高负荷剂量。

Teicoplanin trough concentrations following different loading doses in critically ill patients

ObjectiveTo understand serum trough concentrations (Cmin) of teicoplanin and target concentration achieved in severely infected patients after three days treatment with different loading doses of teicoplanin, and find out optimal loading dose. MethodsSeverely infected patients who admitted to the intensive care unit(ICU) of a hospital from February 1, 2016 to February 28, 2017 were enrolled in the study. According to different drug loading doses (teicoplanin standard dose: 6mg/kg; high dose:10mg/kg) and different creatinine clearance rates (Ccr: 50mL/min as standard value), patients were divided into four subgroups: group of standard dose and normal Ccr (GSD1), group of standard dose and low Ccr (GSD2), group of high dose and normal Ccr ( GHD1), group of high dose and low Ccr(GHD2). Serum Cmin, percentage of achieving target concentration, and adverse reactions of teicoplanin in different groups were compared. ResultsA total of 49 patients were enrolled in the study, 17 patients were in GSD group, Cmin on 4th day before administration was (5.98±2.67)mg/L; 32 patients were in GHD group, Cmin on 4th day before administration was (9.05±4.25)mg/L; Cmin in GHD group was higher than that in GSD group, and there was statistical difference between two groups（t=3.10，P=0.003）. Values of Cmin in GSD1, GSD2, GHD1, and GHD2 groups were (5.78±2.72), (6.34±2.78), (8.21±3.77), and (12.07±4.81 ) mg/L respectively, differences among four groups were statistically significant（F=4.766, P=0.006）. The Cmin in GHD2 group was higher than those in GHD1,GSD2, and GSD1 groups, percentage of achieving the target concentration were 9.09% (1/11), 16.67% (1/6), 28.00%(7/25), and 71.43% (5/7) respectively, differences were statistically significant（χ2=8.766, P=0.033）. Complications associated with teicoplanin such as rash, damage to hepatic and renal function were not observed in all patients during the treatment course. ConclusionWhether the Ccr is normal or not, target Cmin can not be achieved early in patients given teicoplanin with standard loading dose; in patients with low Ccr, given high loading dose, target Cmin can be achieved early; while in patients with normal Ccr, higher loading dose may be needed.