不同剂量万古霉素治疗儿童金黄色葡萄球菌肺炎的血药浓度分析

Analysis of serum vancomycin concentration after administration of different doses in children with Staphylococcus aureus pneumonia

摘要:

目的 分析不同剂量万古霉素治疗儿童金黄色葡萄球菌肺炎（Staphylococcus aureus pneumonia，SAP）的血药浓度，探讨适宜的治疗剂量，为临床用药提供参考。方法 回顾性分析2008 年1 月至2013 年12月35 例使用万古霉素治疗的SAP 患儿临床资料。结果 35 例使用万古霉素治疗的SAP 患儿中，22 例（63%）进行了血药谷浓度监测，治疗剂量为10、12.5 和15 mg/（kg · 次）×q6h 者分别有11、4 和7 例。15 mg/（kg · 次）组平均谷浓度为14.98 mg/L（中位数），显著高于剂量为10 mg/（kg · 次）和12.5 mg/（kg · 次）组患儿（分别为4.97和8.00 mg/L，P<0.05）；15 mg/（kg · 次）组达到万古霉素预计谷浓度的比例（71%）显著高于10 mg/（kg · 次）组（9%），与12.5 mg/（kg · 次）组（25%）比较差异无统计学意义。结论 儿科临床治疗SAP 使用万古霉素的剂量可能以15 mg/（kg · 次）×q6h ，即60 mg/（kg · d），较为合理。

Abstract:

Objective To analyze serum vancomycin concentration after administration of different therapeutic doses in children with Staphylococcus aureus pneumonia (SAP) in order to determine the appropriate dose of vancomycin in clinical administration. Methods The clinical data of 35 children who were diagnosed with SAP and treated with vancomycin from January 2008 to December 2013 were retrospectively analyzed. Results Among the 35 SAP cases with vancomycin therapy, 22 cases (63%) had serum vancomycin trough concentration monitored. The numbers of cases with vancomycin at 10, 12.5, and 15 mg/(kg·dose) × every 6 hours (q6h) were 11, 4 and 7, respectively. The mean serum trough concentration of vancomycin in the 15 mg/(kg·dose) group was 14.98 mg/L, which was significantly higher than in the 10 mg/(kg·dose) and 12.5 mg/(kg·dose) groups (4.97 and 8.00 mg/L respectively; P<0.05). The percentage of cases that reached the expected trough concentration in the 15 mg/(kg·dose) group (71%) was significantly higher than that in the 10 mg/(kg·dose) group (9%), but there was no significant difference in this percentage between the 15 mg/(kg·dose) and 12.5 mg/(kg·dose) groups (71% vs 25%). Conclusions The reasonable dosage of vancomycin for the treatment of pediatric SAP is 15 mg/(kg·dose) × q6h or 60 mg/(kg·d).