Use of vancomycin in high-flux hemodialysis: Experience with 130 courses of therapy
Use of vancomycin in high-flux hemodialysis: Experience with 130 courses of therapy
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DOI：
10.1038/ki.1996.393
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发表时间：
1996-09-01
影响因子：
19.6
通讯作者：
DeVincenzo, N
中科院分区：
文献类型：
--
作者：
Barth, RH;DeVincenzo, N
万古霉素通常以较长的剂量间隔给予血液透析患者，因为血液透析对万古霉素的清除被认为可以忽略不计。然而，我们和其他人已经证明通过高通量血液透析可以显着去除万古霉素。本报告描述了我们使用修正方案进行 89 个万古霉素疗程的经验，其中负荷剂量随后在每次透析治疗后服用 500 mg 剂量，并将结果与使用每周单次给药的 41 个疗程的结果进行了比较。所有患者均使用容量超滤和碳酸氢盐透析液进行高通量膜透析。在输注完成后两小时（峰）和透析前（谷）获得血清万古霉素水平，并通过 Abbot TDX 荧光偏振免疫测定法进行测量。多剂量治疗的持续时间为11+/-8天，平均总剂量为3.6+/-1.8g。 20 mg/kg 的初始剂量可快速可靠地建立治疗性透析前血清水平（10 至 25 μg/ml）。在接受多次给药治疗的患者中，获得了 431 个透析前水平。平均水平为15.9+/-5.7μg/ml； 55 个水平（13%）低于 10 μg/ml，22 个水平（5%）高于 25 μg/ml。在每周治疗一次的患者中，77%的患者在给药后五天时水平低于10μg/ml，84%在一周后水平低于10μg/ml。没有患者出现明显的耳毒性。 25 名患者的治疗时间大于或等于两周，5 名患者的治疗时间大于或等于 4 Reeks，2 名患者的治疗时间大于或等于 5 周，没有证据表明存在毒性累积。平均峰值水平为20.1+/-4.6μg/ml，与先前透析前水平的平均差异为7.2+/-2.2μg/ml。我们的结论是，在高通量血液透析中，万古霉素负荷剂量为 20 mg/kg，每次透析治疗后使用 500 mg 剂量，可达到可预测、充足和安全的治疗水平，不会导致不可接受的高峰，并且不会在长期治疗过程中累积。相比之下，每周一次的万古霉素给药会在五到七天后导致血清水平低于治疗水平，因此在高通量环境中应放弃。
Vancomycin is often administered to hemodialysis patients at long dosage intervals because its removal by hemodialysis is considered to be negligible. We and others, however, have demonstrated significant removal of vancomycin by high-flux hemodialysis. This report describes our experience with 89 courses of vancomycin using a revised regimen with a loading dose followed by 500 mg doses after each dialysis treatment, and compares results with 41 courses using single weekly dosing. All patients were dialyzed with high-flux membranes using volumetric ultrafiltration and bicarbonate dialysate. Serum vancomycin levels were obtained two hours after completion of infusion (peak) and immediately prior to dialysis (trough) and were measured by Abbot TDX fluorescence polarization immunoassay. Duration of multiple-dose therapy was 11 +/- 8 days, with mean total dose 3.6 +/- 1.8 g. Initial doses of 20 mg/kg rapidly and reliably established therapeutic pre-dialysis serum levels (10 to 25 mu g/ml). In patients treated with multiple dosing, 431 pre-dialysis levels were obtained. The mean level was 15.9 +/- 5.7 mu g/ml; 55 levels (13%) were less than 10 mu g/ml and 22 (5%) were above 25 mu g/ml. In patients treated once weekly, 77% of levels were below 10 mu g/ml by five days after administration, and 84% at one week. No patient developed demonstrable ototoxicity. Twenty-five patients were treated for greater than or equal to two weeks, five for greater than or equal to four Reeks, and two for > five weeks, with no evidence of toxic accumulation. Mean peak level was 20.1 +/- 4.6 mu g/ml, with a mean difference from preceding pre-dialysis level of 7.2 +/- 2.2 mu g/ml. We conclude that in high-flux hemodialysis, a 20 mg/kg loading dose of vancomycin followed by 500 mg doses after each dialysis treatment achieves predictable, adequate and safe therapeutic levels, does not lead to unacceptably high peaks, and does not accumulate during long treatment courses. By contrast, once-weekly vancomycin dosing resulted in subtherapeutic serum levels after five to seven days, and should be abandoned in the high-flux setting.