Development of initial loading procedure for teicoplanin in critically ill patients with severe infections.
Development of initial loading procedure for teicoplanin in critically ill patients with severe infections.
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DOI：
10.1248/bpb.b12-00911
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发表时间：
2013-06
影响因子：
2
通讯作者：
Kazuaki Matsumoto;N. Kanazawa;E. Watanabe;Yuta Yokoyama;Tomohide Fukamizu;Y. Shimodozono;C. Maeda;T. Yasuda;Y. Kakihana;K. Ikawa;N. Morikawa;Yasuo Takeda
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文献类型：
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作者：
Kazuaki Matsumoto;N. Kanazawa;E. Watanabe;Yuta Yokoyama;Tomohide Fukamizu;Y. Shimodozono;C. Maeda;T. Yasuda;Y. Kakihana;K. Ikawa;N. Morikawa;Yasuo Takeda
耐甲氧西林金黄色葡萄球菌(MRSA)目前在许多医院流行。与普通病房相比，重症监护病房(ICU)感染MRSA的频率更高。因此，对耐甲氧西林金黄色葡萄球菌感染的适当治疗将导致ICU的良好结果。替考拉宁是一种抗MRSA药物。最近，它被推荐在15-30微克/毫升的新的靶浓度。然而，替考拉宁的初始加载程序使其迅速达到目标浓度仍不确定。因此，本研究旨在确定危重病合并严重感染患者合适的替考拉宁初始负荷程序。我们对在ICU接受替考拉宁治疗的患者进行了一项回顾性研究，以确定迅速达到目标药物浓度的初始负荷程序。然后，我们在替考拉宁治疗开始后的第三天评估谷浓度。平均负荷量为11.5±1.0 mg/kg，谷浓度为18.9±5.9微克/毫升。替考拉宁负荷剂量与谷浓度呈正相关(r=0.45，p=0.046)。相关方程为谷浓度=2.563·负荷剂量-10.672。负荷量分别为11.0和15.0 mg/kg时，谷浓度分别为17.5和27.8微克/毫升。我们建议在ICU开始应用替考拉宁后的第3天，应给予初始负荷剂量11~15 mg/kg，每12h一次，共3次，以迅速达到15~30µg/mL的目标谷浓度。
Methicillin-resistant Staphylococcus aureus (MRSA) is now endemic in many hospitals. Infection with MRSA is more frequent in the intensive care unit (ICU) than in general wards. Therefore, appropriate treatments for MRSA infections will lead to good outcomes in the ICU. Teicoplanin is an anti-MRSA agent. Recently, it was recommended at a new target trough concentration of 15-30 µg/mL. However, the initial loading procedure for teicoplanin to allow it to reach the target concentration promptly remains uncertain. Therefore, this study aimed to determine the appropriate initial loading procedure for teicoplanin in critically ill patients with severe infections. We performed a retrospective study in patients given teicoplanin in the ICU in order to determine the initial loading procedure to promptly reach the target trough concentration. We then evaluated the trough concentration on the third day after commencement of teicoplanin therapy. The mean loading dose and trough concentration were 11.5±1.0 mg/kg and 18.9±5.9 µg/mL, respectively. A correlation (r=0.45, p=0.046) was shown between teicoplanin loading dose and trough concentration. The correlation equation was trough concentration=2.563·loading dose -10.672. In the cases of 11.0 and 15.0 mg/kg for the loading dose, respectively, trough concentrations were 17.5 and 27.8 µg/mL. We suggested that an initial loading dose of 11-15 mg/kg every 12 h for 3 doses should be administered to promptly achieve the target trough concentration of 15-30 µg/mL on the third day after commencement of teicoplanin therapy in the ICU.