ICU患者替考拉宁给药方式及药物浓度监测的临床意义探讨

中国临床药理学与治疗学 ›› 2011, Vol. 16 ›› Issue (5): 538-544.

ICU患者替考拉宁给药方式及药物浓度监测的临床意义探讨

李昊^1,3, 王雪¹, 董海燕², 董亚琳², 田刚³

¹西安交通大学第一附属医院重症医学科,
²药学部,
³心内科,西安 710061,陕西

收稿日期:2011-04-15 修回日期:2011-05-11 发布日期:2011-07-08
通讯作者: 王雪,女,博士,副主任医师,硕士生导师,研究方向:危重症患者的血流动力学以及药动学。Tel:18991232241 E-mail:wangxuejd2008@126.com
作者简介:李昊,女,在读博士研究生,助理研究员,研究方向:危重症患者的血流动力学以及药动学研究。Tel:18991232582 E-mail:lihao215@stu.xjtu.edu.cn
基金资助:
西安交通大学第一附属医院基金(2008yk29)

Clinical analysis of therapeutic drug monitoring and drug dosage for ICU patients treated with teicoplanin

LI Hao^1,3, WANG Xue¹, DONG Hai-yan², DONG Ya-lin², TIAN Gang³

¹Department of Critical Care Medicine First Affiliated Hospital of Medical College of Xi'an Jiaotong University,
²Department of Pharmacy,
³Department of Cardiology, Xi'an 710061, Shaanxi, China

Received:2011-04-15 Revised:2011-05-11 Published:2011-07-08

摘要/Abstract

摘要： 目的: 探讨替考拉宁的合理给药方式及进行治疗药物浓度监测(TDM)的必要性。方法: 对使用替考拉宁治疗的20例重症感染患者的临床资料进行回顾性分析,按照治疗前 3 d 平均起始给药剂量(MID)的不同,分为MID=533.33 mg/d 组10例和MID<533.33 mg/d 组10例,所有患者治疗期间采集血样,应用高效液相色谱法(HPLC)测量替考拉宁血药谷浓度(C_min)。结果: 研究发现替考拉宁C_min与初始给药剂量密切相关,其Pearson相关性为 0.685,双侧显著性检验均为 0.01,使用起始负荷剂量的患者C_min明显高于不采用起始负荷量的患者(P<0.01),且治疗效果亦明显好于不予以起始负荷量的患者(P<0.01),两组病人的药物不良反应发生率差异无统计学意义。结论: 重症监护病房(ICU)患者在使用替考拉宁时需要予以规范的起始负荷给药方式,以期快速达到有效药物治疗浓度,取得良好的治疗效果,同时应根据TDM结果协助调整给药剂量,避免替考拉宁药物不良反应的发生。

关键词: 抗生素, 替考拉宁, 治疗药物浓度监测, 负荷量

Abstract: AIM: To study the necessity of TDM and a reasonable dose of teicoplanin.METHODS: The clinical data of 20 patients who were suffered with severe infection and treated with teicoplanin were retrospectively analyzed.According to the MID, patients were divided into two groups: group1 (MID=533.33 mg/d, n=10), group2 (MID<533.33 mg/d, n=10).The C_min of teicoplanin was measured by HPLC.RESULTS: The C_min of teicoplanin was closely related to initial dose, Pearson correlation was 0.685 and the correlation was significant at the 0.01 level (2-tailed). The C_min and the therapeutic effect of patients who were accepted the initial load dose of teicoplanin was higher and better than the patients who weren't accepted the initial load dose (P<0.01).There was no statistically difference in two groups with the frequency of side-effect.CONCLUSION: The findings suggest that a regular initial load dose of teicoplanin make it possible to rapidly attain an optimal trough concentration and acquire a good therapeutic effect.It is necessary for ICU patient who is treated with teicoplanin to regulate dose by the result of TDM to avoid the side-effect.

Key words: Antibiotic, Teicoplanin, Therapeutic drug monitoring, Load dose

中图分类号:

李昊, 王雪, 董海燕, 董亚琳, 田刚. ICU患者替考拉宁给药方式及药物浓度监测的临床意义探讨[J]. 中国临床药理学与治疗学, 2011, 16(5): 538-544.

LI Hao, WANG Xue, DONG Hai-yan, DONG Ya-lin, TIAN Gang. Clinical analysis of therapeutic drug monitoring and drug dosage for ICU patients treated with teicoplanin[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(5): 538-544.

参考文献

[1] Soy D, López E, Ribas J. Teicoplanin population pharmacokinetic analysis in hospitalized patients [J]. Ther Drug Monit, 2006, 28(6): 737-743.
[2] MacGrowan AP. Pharmacodynamics, pharmacokinetics and therapeutic drug monitoring of glycopeptides [J]. Ther Drug Monit, 1998, 20(5): 473-477.
[3] Matsumoto K, Kanazawa N, Ikawa K, et al. Determination of teicoplanin trough concentration target and appropriate total dose during the first 3 ds: a retrospective study in patients with MRSA infections [J]. J Infect Chemother, 2010, 16(3):193-199.
[4] Sato M, Chida K, Suda T, et al. Recommended initial loading dose of teicoplanin, established by therapeutic drug monitoring, and outcome in terms of optimal trough level [J].J Infect Chemother, 2006, 12(4): 185-189.
[5] Harding I, MacGowan AP, White LO, et al. Teicoplanin therapy for staphylococcus aureus septicaemia: relationship between pre-dose serum concentrations and outcome [J]. J Antimicrob Chemother , 2000, 45(6): 835-841.
[6] Pea F, Brollo L,Viale P, et al. Teicoplanin therapeutic drug monitoring in critically ill patients: a retrospective study emphasizing the importance of a loading dose [J]. J Antimicrob Chemother, 2003, 51(4): 971-975.
[7] Jie S, Zheng J, Zhou YN,et al. Quantification of teicoplanin in human plasma by liquid chromatography with ultraviolet detection [J]. Chromatographia, 2006, 10(65): 1365.
[8] Nevile LO, Balliod R, Grady D, et al. Teicoplanin in patients with chronic renal failure on dialysis: microbiological and pharmacokinetic aspects [J]. Int J Clin Pharmacol Res, 1987, 7(6): 485-490.
[9] Meyer B, Traunmüller F, Hamwi A, et al. Pharmacokinetics of teicoplanin during continuous hemofiltration with a new and a 24-h used highly permeable membrane: rationale for therapeutic drug monitoring-guided dosage [J]. Int J Clin Pharmacol Ther, 2004, 42(10): 556-560.
[10] Kroh UF, Dinges GK, Lukasewitz P, et al. Elimination of drugs by the new polyamide -hemofilter FH77H during various in vitro conditions [J]. Blood Purif, 1998, 16(1): 49-56.
[11] 华俊彦,田伟强,朱雅艳,等. 万古霉素治疗耐药甲氧西林金黄色葡萄球菌的疗效和血药浓度 [J].中国临床药理学与治疗学,2010, 15(6): 673-677.
[12] Niwa T, Imanishi Y, Ohmori T, et al. Significance of individual adjustment of initial loading dosage of teicoplanin based on population pharmacokinetics [J]. Int J Antimicrob Agents, 2010, 35(5): 507-510.
[13] Pauluzzi S, Del Favero A, Menichetti F, et al. Treatment of infections by staphylococci and other gram-positive bacteria with teicoplanin: an open study [J]. J Antimicrob Chemother, 1987, 20(3): 431-438.
[14] Alfandari S, Levent T, Descamps D, et al. Evaluation of glycopeptide use in nine French hospitals [J]. Med Mal Infect, 2010, 40(4): 232-237.

[1]	汪飞, 杭永付, 王未. 重症患者肾功能亢进对替考拉宁血药浓度影响分析[J]. 中国临床药理学与治疗学, 2023, 28(9): 1043-1048.
[2]	徐涛, 朱素燕, 邱相君, 徐萍. 肾功能不全患者人群中替考拉宁群体药代动力学模型的建立与验证[J]. 中国临床药理学与治疗学, 2022, 27(9): 977-983.
[3]	何杰, 刘冬雪, 钟羚君, 邵华, 胡琳璘. 重症患者体内米卡芬净暴露量有限采样法估算模型的建立[J]. 中国临床药理学与治疗学, 2022, 27(11): 1264-1271.
[4]	华旭丹，解红艺，余淑芳. C反应蛋白和降钙素原指导高危新生儿预防性应用抗生素的效果、安全性和经济性分析[J]. 中国临床药理学与治疗学, 2019, 24(5): 561-566.
[5]	王之恒，王元银. 抗生素联合激素治疗夜间急诊牙痛的临床研究[J]. 中国临床药理学与治疗学, 2016, 21(10): 1163-1167.
[6]	李春杏, 付强, 朱珠. 利奈唑胺组织穿透性及在感染组织中的药效学[J]. 中国临床药理学与治疗学, 2015, 20(3): 349-355.
[7]	尚利娜, 洪明岳. 抗肿瘤抗生素抗体靶向药物研究新进展[J]. 中国临床药理学与治疗学, 2014, 19(9): 1075-1080.
[8]	汪红, 胡龙华, 宁长秀, 杭亚平, 钟桥石, 胡晓彦, 章白苓, 贾坤如. 耐碳青霉烯类抗生素鲍曼不动杆菌耐药机制的研究[J]. 中国临床药理学与治疗学, 2014, 19(10): 1093-1098.
[9]	谢刚, 安昌勇, 张才全, 唐华. 肠道抗生素行肠道准备后对大肠杆菌耐药的影响[J]. 中国临床药理学与治疗学, 2013, 18(4): 433-437.
[10]	孙渊, 査伟斌, 周芳, 吴晓兰, 张经纬, 王广基. 细菌外排泵与抗生素耐药的相关性[J]. 中国临床药理学与治疗学, 2012, 17(5): 593-600.
[11]	王瑶瑶, 周芳, 张经纬, 宋大炜, 李松潞, 査伟斌, 吴晓兰, 王广基. 抗生素胞内抗菌活性及其细胞药代动力学评价的研究进展[J]. 中国临床药理学与治疗学, 2012, 17(12): 1419-1426.
[12]	李景荣, 熊术道, 梁欢, 卢中秋. 创伤弧菌脓毒症大鼠肝脏MMP-2、MMP-9及TIMP-2基因表达及抗菌药物干预对其的影响[J]. 中国临床药理学与治疗学, 2009, 14(4): 410-415.
[13]	朱曼, 王睿, 张永青, 梁蓓蓓. 加替沙星和环丙沙星体外抗生素后效应期间大肠埃希菌形态学观察及膜电位和膜通透性变化[J]. 中国临床药理学与治疗学, 2005, 10(9): 1005-1009.
[14]	罗伟良, 徐剑斌, 黄林辉, 许南燕, 邱金华, 刘武. 华法林负荷量法抗凝治疗短暂性脑缺血发作的研究[J]. 中国临床药理学与治疗学, 2004, 9(6): 705-708.
[15]	张永青, 王睿, 朱曼, 张健鹏, 张咏梅, 同军. 原子力显微镜观察头孢美唑抗生素后效应期间大肠埃希菌形态学特征[J]. 中国临床药理学与治疗学, 2004, 9(10): 1123-1127.