Purpose An original and a revised vancomycin dosing protocol for obese patients were compared with respect to attainment of target serum trough vancomycin concentrations and the occurrence of nephrotoxicity.
目的：通过测定患者血清万古霉素波谷浓度和肾毒性发生率，对比修正的与原始的患者剂量方案。
Methods The attainment of target vancomycin trough values (10–20 μg/mL) and nephrotoxicity were compared retrospectively between an original protocol (vancomycin 15 mg/kg i.v. every 8–12 hours), which had been associated with high troughs, and a revised protocol (10 mg/kg i.v. every 12 hours or 15 mg/kg every 24 hours). Patients were included if they were obese (weight ≥ 100 kg and total body weight ≥ 140% of ideal body weight), had normal renal function (creatinine clearance ≥ 60 mL/min), had received i.v. vancomycin for at least 48 hours, and had one evaluable vancomycin trough value. Nephrotoxicity was defined as an increase in serum creatinine concentration of 0.5 mg/dL or of 50% over baseline, whichever was greater.
方法：将病例分为原始方案治疗组(万古霉素 15 mg/kg i.v. 每8–12 hours 1次)和修正治疗组(10 mg/kg i.v. 每12 小时1次，或 15 mg/kg 每24小时1次)，两组分别检测目标万古霉素波谷值(10–20 μg/mL)及肾毒性。纳入标准：肥胖(体重 ≥ 100 kg 和总体重≥ 140% 理想体重), 肾功能正常(肌酐清除率≥ 60 mL/min), 静脉使用万古霉素至少已48小时，获得可评价的万古霉素波谷值。肾毒性定义为血清肌酐浓度增高0.5 mg/dL或较基线增加50% 以上。
Results Seventy-four and 64 patients were stratified into groups that had been treated with the revised and original protocols, respectively. The mean ± S.D. maintenance dose was 19 ± 2 mg/kg/day with the revised protocol and 34 ± 7 mg/kg/day with the original protocol (p < 0.001). Compared with the original protocol, the revised protocol resulted in a higher frequency of target troughs (59% versus 36%, p = 0.006) and below-target troughs (23% versus 9%, p = 0.033) and a lower frequency of above-target troughs (18% versus 55%, p < 0.001). Nephrotoxicity occurred in two patients in each group.
结果：修正方案和原始方案组分别纳入74和64个患者。修正组维持剂量为19 ± 2 mg/kg/日 （均数± 标准差），而原始方案组为34 ± 7 mg/kg/日(p < 0.001)。与原始方案对比，修正方案达到目标波谷值的频率更高(59%比36%, p = 0.006)，小于目标波谷的频率也更高(23% 比 9%, p = 0.033)，而高于目标波谷的频率更低(18% 比55%, p < 0.001)。两组中各有2个患者出现肾毒性。
Conclusion Compared with the original vancomycin protocol for obese patients, a revised vancomycin protocol using lower total daily doses improved the attainment of target trough concentrations, with minimal nephrotoxicity.
结论：与肥胖患者原始万古霉素治疗方案对比，修正后的方案获得目标波谷浓度的每日用药剂量更小，肾毒性最小。
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探讨肥胖患者万古霉素应用的剂量方案
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