頁籤選單縮合
| 題 名 | 回溯性研究小兒Vancomycin治療劑量=A Retrospective Study of Vancomycin Therapeutic Dosing in Pediatric Patients |
|---|---|
| 作 者 | 蕭如君; 李建瑩; 許績男; | 書刊名 | 藥學雜誌 |
| 卷 期 | 35:3=140 2019.09[民108.09] |
| 頁 次 | 頁110-116 |
| 分類號 | 418.281 |
| 關鍵詞 | 小兒族群; 波谷濃度; Vancomycin; Pediatric population; Trough concentration; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 背景:以病歷回溯方式探討本院小兒族群 vancomycin 使用現況,提供小兒 vancomycin 適當治療劑量參考。 方法: 納入條件為: 中區某醫學中心新生兒及兒科加護病房與兒科病房 2011/01-2017/12腎功能正常,住院年齡為 > 7天至 < 16歲,住院期間至少使用過3 劑 vancomycin,血中濃度達穩定狀態且有療效濃度監測之小兒病人。排除條件為: vancomycin 坡谷 (trough) 抽血時間不正確、腎功能不全患者 (eGFR < 60 mL/min /1.73 m2)、重症危急病人 (存在 ≧ 1個臟器功能衰竭)、出生體重 < 2000 gm 之新生兒。設 定評估的目標為個別 vancomycin 日劑量所得之 trough 分佈及 trough > 20 μg/mL 發生 率。運用 Statistical Product and Service Solutions (SPSS) 軟體分析,以交叉表及 ROC 曲 線 (Receiver operating characteristic curve) 呈現結果。 結果:最後總計納入135個檢驗值,AUC = 0.703 (95 % CI= 0.614-0.792) 顯示具可 接受的鑑別力。結果顯示在新生兒及嬰兒族群中給予 vancomycin 傳統治療劑量 (40-60 mg/kg/day) 分別有69.2%與61.9%可達治療目標濃度 (10-20 μg/mL),發生 trough > 20 μg/mL 分別有7.7%與9.5%;嬰兒使用日劑量 > 60 mg/kg/day 並未發生 trough > 20 μg/ mL 事件。兒童及青少年族群使用日劑量40-60 mg/kg/day 分別有81.5%與66.7% trough < 10 μg/mL,普遍未達治療目標濃度,其達標結果分析並無統計學上意義,未來需 更大型研究證實。當給予 vancomycin 日劑量 > 70 mg/kg/day 有33.3%發生 trough > 20 μg/mL 風險。 結論:依據達到治療濃度研究顯示目前本院 vancomycin 所使用的傳統治療劑量(40-60 mg/kg/day) 在新生兒及嬰兒族群中應是適當劑量,臨床必要時小兒族群可提 高日劑量至70 mg/kg/day。劑量 > 70 mg/kg/day 則可能有1/3機率超出治療目標濃度風 險。本研究結果可提供予非重症腎功能正常使用 vancomycin 的小兒族群患者臨床治療 劑量參考,唯 vancomycin 可能存在個體差異性,臨床上亦需多加考量。 |
| 英文摘要 | Background: By using retrospective cohort study design, we aimed to explore the current usage of vancomycin among pediatric population in our hospital and subsequently finding the appropriate therapeutic dosage for clinical application. Methods: Inclusion criteria: hospitalized patients in neonatal and pediatric intensive care unit and pediatric ward in a medical center located at center of Taiwan from 2011/01 to 2017/12,normal renal function, admission age > 7 days to < 16 years old, using at least 3 doses of vancomycin during hospitalization, serum concentration reaching the steady state and continuously under therapeutic drug monitoring.Exclusion criteria: Incorrect timing of blood sample collection of vancomycin trough, renal insufficiency (eGFR < 60 mL/min/1.73 m2) ,critically ill patients(having at least one organ failure), newborns birth weight < 2000 gm. The end point of this study was to evaluate individual vancomycin daily dose of trough distribution and incidence of trough > 20 μg/mL. Statistical Product and Service Solutions (SPSS) software was used to analyze, results were presented in forms of cross tab and ROC curve (Receiver operating characteristic curve). Results: A total of 135 examined values were eventually selected. AUC = 0.703 (95 % CI = 0.614 - 0.792) indicated an acceptable discrimination. The results revealed that in neonate and infant group using traditional dosage (40-60 mg/kg per day),69.2 % and 61.9 %,respectively, could reach the goal of therapeutic concentration, while the rates of trough > 20 μg/mL were 7.7 % and 9.5% respectively. There was no incident of trough > 20 μg/mL in infant when using daily dose > 60 mg/kg/per day. Among children and adolescent group using traditional dosage (40-60 mg/kg per day), the rates of vancomycin trough < 10 μg/mL were 81.5% and 66.7% respectively, revealing that therapeutic concentration was not attained in most subjects. However, for those reaching the therapeutic concentration showed no statistical significance.A larger study is needed to confirm these findings. This study demonstrated that if the daily dose of vancomycin > 70 mg/ kg per day was given, there was 33.3% of risk seeing trough > 20 μg/mL. Conclusion: According to the therapeutic concentration result revealed that traditional vancomycin therapeutic dose (40-60 mg/kg/day) was appropriate for clinical use among neonate and infant population in our hospital. The concentration could reach the dose to 70 mg/kg per day if clinically required in pediatric population. Dose > 70 mg/kg per day was found to have 1/3 risk of exceeding the therapeutic target concentration. The results of study offer noteworthy clinical application with regards to proper dosage of vancomycin among pediatric population having normal renal function and no critical illness.However, extra caution should always be taken as individual variations in drug response exist. |
本系統中英文摘要資訊取自各篇刊載內容。