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題 名 | 監測小兒Vancomycin之波峰濃度=Measuring Serum Vancomycin Peak Levels for Children |
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作 者 | 郭小懷; 胡雅姿; 羅凱薰; 林育成; | 書刊名 | 藥學雜誌 |
卷 期 | 29:1=114 2013.03[民102.03] |
頁 次 | 頁61-65 |
分類號 | 418.281 |
關鍵詞 | 藥物治療監測; 小兒; 波峰濃度; 波谷濃度; Vancomycin; Therapeutic drug monitoring; |
語 文 | 中文(Chinese) |
中文摘要 | 定期監測 vancomycin 血中濃度的必要性一直無法被確立,尤其是否需要測量vancomycin 波峰濃度來避免造成副作用仍是備受爭議。本研究藉由觀察「波谷濃度在合理治療範圍內時,波峰濃度的變化」,來探討腎功能正常之小兒測量 vancomycin 波峰濃度的必要性。本研究回溯性的收集某區域教學醫院自民國98年1月至100年9月有作 vancomycin 藥物治療監測 (therapeutic drug monitoring,TDM),且同時有波峰濃度和波谷濃度數據的,對象是小於18歲腎功能正常之病童。共53組數據被納入,沒有耳毒性及腎毒性被提報。波谷濃度達到治療濃度的病人中只有75%的波峰濃度介於合理範圍內,亦即另外25%非介於合理範圍,所以若要單仰賴 vancomycin 波谷濃度的數據來評估療效或調整劑量未必合適可靠。另外,依藥物動力學考量,準確估算劑量是需要一組波谷和波峰濃度的,因此即使沒有足夠的證據可以證明監測波峰濃度可以減少副作用的發生,我們仍建議波谷濃度和波峰濃度皆須監測。 |
英文摘要 | The necessity of regularly monitoring serum vancomycin concentration has not been fully established, especially, the measurement of vancomycin peak level. The purpose of this study is to discuss the necessity of measuring serum vancomycin peak levels for children with normal renal function by evaluating the variation in peak levels when trough levels are within the normal ranges. This retrospective study included children (<18 years) who admitted a regional teaching hospital from Jan. 2009 to Sep. 2011, and had vancomycin therapeutic drug monitoring (TDM) records. Patients with renal insufficiency and wrong sampling time were excluded. 53 pairs of TDM results were analyzed in the study. No ototoxic and nephrotoxic events observed. Among the patients who had normal trough levels, 75% of them had normal peak levels, 25% were not within the normal range. The result might indicate that it is unreliable to assess effectiveness or adjust dosage only based on trough levels. Considering pharmacokinetics principles, pharmacists need at least one trough and one peak levels to calculate the appropriate dosing of vancomycin. Although no clear evidence shows the apparent benefits of monitoring vancomycin peak levels, we would still suggest to measure both peak and trough levels for vancomycin dosing in pediatric patients. |
本系統中英文摘要資訊取自各篇刊載內容。