Vancomycin Advanced Therapeutic Drug Monitoring: Exercise in Futility or Virtuous Endeavor to Improve Drug Efficacy and Safety?
Vancomycin Advanced Therapeutic Drug Monitoring: Exercise in Futility or Virtuous Endeavor to Improve Drug Efficacy and Safety?
复制标题
DOI：
10.1093/cid/ciaa1354
复制
发表时间：
2021-05-15
影响因子：
11.8
通讯作者：
Rose, Warren E.
中科院分区：
文献类型：
--
作者：
Dilworth, Thomas J.;Schulz, Lucas T.;Rose, Warren E.
万古霉素通常用于住院患者。数十年的药代动力学/药效学研究最终建议监测浓度-时间曲线下面积（AUC）与最小抑制浓度的比值，以优化万古霉素暴露并最大限度地减少2020年修订指南中的毒性。这些指南建议是基于有限的数据，没有高质量的证据和强度的限制。尽管在万古霉素治疗药物监测（TDM）方面付出了相当大的努力，但临床医生应该认识到大多数万古霉素的使用是经验性的。大多数经验性万古霉素处方的患者不需要超过几天。对于这些患者，万古霉素暴露最初几天的AUC测定无效。这种增加的工作量可能会影响高水平的患者护理活动。负荷剂量可能会达到AUC目标，因此负荷剂量后的AUC监测对于广泛应用来说基本上是不必要的。几十年来，过量的万古霉素TDM一直在传播，但证据有限，应谨慎对待当代万古霉素TDM建议。
Vancomycin is commonly prescribed to hospitalized patients. Decades of pharmacokinetic/pharmacodynamic research culminated in recommendations to monitor the ratio of the area under the concentration-time curve (AUC) to the minimum inhibitory concentration in order to optimize vancomycin exposure and minimize toxicity in the revised 2020 guidelines. These guideline recommendations are based on limited data without high-quality evidence and limitations in strength. Despite considerable effort placed on vancomycin therapeutic drug monitoring (TDM), clinicians should recognize that the majority of vancomycin use is empiric. Most patients prescribed empiric vancomycin do not require it beyond a few days. For these patients, AUC determinations during the initial days of vancomycin exposure are futile. This added workload may detract from high-level patient care activities. Loading doses likely achieve AUC targets, so AUC monitoring after a loading dose is largely unnecessary for broad application. The excessive vancomycin TDM for decades has been propagated with limitations in evidence, and it should raise caution on contemporary vancomycin TDM recommendations.