基于日本2016年新版抗菌药物治疗药物监测指南的常规计算机软件与Nomogram万古霉素初始剂量设定测谷值比较

Yasuhiro Kamioka, Hitoshi Suzuki, M. Seki, Ryusuke Ouchi, Shota Kashiwagura, Satoshi Koshika, Yoshiteru Watanabe
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引用次数: 1

摘要

背景:由于万古霉素注射液(VCM)具有较高的肾毒性,因此在第3天设定一个10 - 20 μg/mL的起始剂量对于确保安全性和减少副作用非常重要,特别是对于肾功能低下的患者。为了解决这些问题,修订后的2016年抗微生物药物治疗药物监测(TDM)指南(GL2016)建议使用基于肾功能的估计肾小球滤过率(eGFR)图来设定VCM的剂量。方法:我院于2016年9月引进GL2016用于VCM患者。在使用1)常规VCM分析软件和2)GL2016 eGFR图设定初始VCM剂量后,本研究比较和评估第3天的测量谷值。结果:使用VCM分析软件,a-total组(n = 53)的平均测谷值为12.8±4.7 μg/mL。在eGFR图上,b-total组(n = 13)的平均测谷值为9.6±4.6 μg/mL。但比较不同程度肾功能时,G2及以上受试者(eGFR≥60 mL/min/1.73 m2) b-1组的平均测谷值明显低于a-1组,而G3及以下受试者(eGFR 60 mL/min/1.73 m2) a-2组与b-2组之间基本相同。达到各种波谷范围的被试比例呈现出类似的趋势。结论:这些数据提示,基于GL2016的eGFR图建立初始剂量时,第3天测量的谷值普遍较低,这在肾功能正常的患者中尤为突出。对于肾功能较低的受试者,在保证安全性的前提下,谷值相对较高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of Measured Trough Values after Deriving the Initial Dose Setting of Vancomycin with a Conventional Computer Software and a Nomogram Based on the Revised Japanese 2016 Therapeutic Drug Monitoring Guidelines for Antimicrobial Agents
Background: Due to the relatively high renal toxicity of vancomycin injection (VCM), setting an initial dose that achieves a trough that ranges between 10 and 20 μg/mL on day 3 is important to ensure safety and minimize side-effects, especially for patients with low renal function. To address these issues, the revised 2016 Therapeutic Drug Monitoring (TDM) Guidelines for Antimicrobial Agents (GL2016) proposed the use of a renal function-based, estimate glomerular filtration rate (eGFR) nomogram for setting the dose of VCM in Japan. Methods: Our hospital introduced the use of the GL2016 in September 2016 for the patients administered VCM. After setting the initial VCM dose using 1) a conventional VCM analysis software and 2) the GL2016 eGFR nomogram, the measured trough values on day 3 were compared and evaluated in this study. Results: With the VCM analysis software, the mean measured trough value in the a-total group (n = 53) was 12.8 ± 4.7 μg/mL. With the eGFR nomogram, the mean measured trough value in the b-total group (n = 13) was 9.6 ± 4.6 μg/mL. However, when the different severities of renal function were compared, the mean measured trough value was more significantly lower in the b-1 group than in the a-1 group among subjects with G2 and above (eGFR ≥ 60 mL/min/1.73 m2), but it was similar between the a-2 group and the b-2 group among subjects with G3 and below (eGFR 60 mL/min/1.73 m2). The proportion of subjects reaching the various trough ranges shows similar tendency. Conclusions: These data suggested that the measured trough value on day 3 was generally lower when the initial dose was established using the eGFR nomogram based on the GL2016, and this was especially prominent among patients with normal renal function. As for subjects with low renal function, the trough values were relatively high while ensuring safety.
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