10.3389/fpsyg.2012.00132

Vollständiger Abstract

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<h4>Background</h4>Optimizing vancomycin therapy requires balancing efficacy and toxicity. Although therapeutic drug monitoring (TDM) guided by area-under-the-curve (AUC) measurements is now recommended, the effect of dosing frequency and patient-specific factors remain underexplored. This study examined the relationships of dosing frequency, pharmacokinetic/pharmacodynamic (PK/PD) parameters, clinical efficacy, and toxicities in patients receiving different vancomycin regimens.<h4>Methods</h4>This retrospective cohort study analyzed 193 vancomycin dosing regimens in 148 adult patients who were treated at a tertiary teaching hospital in China between January 2013 and March 2021, 175 of which were guided by TDM. The full TDM-guided cohort (n = 175) was used for analysis of safety and PK; clinical efficacy was assessed in 59 culture-confirmed cases; and the association of PK/PD parameters with efficacy was examined in the 26 patients who received a 1 g q12 h regimen for staphylococcal infections.<h4>Results</h4>In the subset of 26 patients with staphylococcal infections who received the 1 g q12 h regimen, clinical success was not significantly associated with C trough , AUC, or AUC/minimum inhibitory concentration (AUC/MIC). For the entire TDM-guided cohort, dosing frequency was a significant and independent determinant of C trough (P = 0.031), in that more frequent dosing led to higher C trough values without altering total daily AUC. Receiver operating characteristic (ROC) analysis indicated that AUC was a better predictor of nephrotoxicity (AUROC = 0.754) than C trough (AUROC = 0.659). Multivariate analysis confirmed that pre-treatment creatinine clearance was the primary predictor of post-treatment renal function. Female gender was an independent risk factor for post-treatment anemia (P = 0.002).<h4>Conclusion</h4>Among the 26 patients with staphylococcal infections receiving the 1 g q12 h regimen, traditional PK/PD targets (C trough and AUC/MIC) did not correlate with clinical efficacy in this real-world setting. AUC was a better predictor of nephrotoxicity than C trough , and female gender was an independent risk factor for vancomycin-associated anemia.

Abstract: PubMed · Datensatz