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在急诊科使用万古霉素负荷会导致较高的最低有效治疗水平
原作者: Bryan Hayes, 江利冰 翻译, 发布日期:2015-12-07

Title: Vancomycin Loading in the ED Leads to Higher Trough Levels
题目:在急诊科使用万古霉素负荷会导致较高的最低有效治疗水平
Author: Bryan Hayes
作者:Bryan Hayes
翻译:江利冰 校对:肖锋

We know vancomycin should be dosed based on weight rather than the default 1 gm dose so many patients receive. But do higher loading doses in the ED actually lead to more therapeutic trough levels?
我们知道万古霉素的剂量应该根据体重进行调整,而不是所有的患者都默认使用1 gm。急诊室高负荷量真的可以带来更长时间的最低有效治疗水平?

New Data
新数据
A new randomized trial compared ED patients receiving 30 mg/kg initial doses vs. 15 mg/kg. There was a significantly greater proportion of patients reaching target trough levels of 15 mg/L at 12 hours among the patients who received a 30 mg/kg loading dose as compared with a traditional 15 mg/kg dose (34% vs 3%, P < 0.01). This study did not use a max dose of 2 gm. They included patients up to 120 kg who received 3.6 gm loading doses! There was no difference in incidence of nephrotoxicity between the groups.
一项新的随机对照研究,比较了急诊科患者使用30 mg/kg 和15 mg/kg的初始剂量。和接受15 mg/kg负荷剂量的患者相比,更多的接受30 mg/kg负荷剂量的患者,在12h到达了目标治疗有效最低水平(34% vs 3%, P < 0.01)。该研究没有使用最大剂量2gm。纳入的患者中包括体重120kg接受3.6gm负荷量的患者!两组之间肾毒性的发生率没有区别。

Application to Clinical Practice
应用于临床实践
• Advocate for change in your ED's order sets to weight-based dosing of vancomycin and remove 1 gm as a default option. [2, 3]
• 建议急诊科万古霉素应该改为根据体重调整剂量,并去除默认的1gm。
• While 34% attaininment of adequate trough levels still isn't great, properly loading vancomycin with up to 30 mg/kg is a step in the right direction. It also takes longer than one dose to reach steady-state levels.
• 尽管达到34%的最低有效浓度仍然是不够的,适当的增加万古霉素的剂量,直到最大剂量30mg/kg是正确的。要想到达稳定的水平是需要多于一个剂量的万古霉素。
• This study did not evaluate clinical cure rates, just trough levels.
• 该研究没有评估临床治愈率,仅仅是最低有效浓度。

References
参考文献
Rosini JM, et al. A randomized trial of loading vancomycin in the emergency department. Ann Pharmacother 2015;49(1):6-13. http://www.ncbi.nlm.nih.gov/pubmed/25358330
Frankel KC, et al. Computerized provider order entry improves compliance of vancomycin dosing guidelines in the emergency department. Am J Emerg Med, 2013,31(12):1715-1716.
http://www.ncbi.nlm.nih.gov/pubmed/24144562
Hall AB, et al. The effects of an electronic order set on vancomycin dosing in the ED. Am J Emerg Med 2015;33(1):92-94. http://www.ncbi.nlm.nih.gov/pubmed/25445870