不同剂量替考拉宁治疗老年重症革兰阳性菌感染患者的治疗药物浓度监测与疗效评估

Monitoring of drug concentrations of elderly patients with severe gram-positive bacteria infections treated with different dosages of teicoplanin and assessment of curative effect

目的评价不同剂量替考拉宁在治疗老年重症革兰阳性菌感染患者的血药谷浓度（Cmin）、临床疗效及不良反应,探讨替考拉宁合理的给药方式及进行治疗药物浓度监测（TDM）的必要性。方法选取医院2015年3月-2016年2月收治52例老年重症革兰阳性菌感染患者,分为观察组24例,对照组28例,观察组给予替考拉宁针第1~3日0.4g,每12h1次,静脉滴注,此后0.4g,每天一次,静脉滴注;对照组按常规剂量给予替考拉宁针第1日0.4g,每12h1次,静脉滴注,此后0.4g,每天一次,静脉滴注,治疗期间采集血样,检测替考拉宁Cmin,比较两组患者Cmin、临床有效率、细菌清除率及不良反应发生率。结果观察组及对照组替考拉宁的Cmin分别为（22.04±11.02）mg/l、（13.62±2.66）mg/l;临床有效率分别为91.6%、78.6%;细菌清除率分别为87.5%、71.4%;不良反应发生率为8.3%、3.6%,两组间患者Cmin比较,差异有统计学意义（P〈0.05）。结论初始应用高剂量及维持剂量替考拉宁治疗老年重症革兰阳性菌感染患者效果良好,可达到有效Cmin,且不良反应无增加,建议可在监测替考拉宁Cmin的同时提高替考拉宁的用量,以期提高替考拉宁的有效率。

OBJECTIVE To evaluate the serum minimum concentration（Cmin）,clinical efficacy,and adverse reactions of elderly patients with severe gram-positive bacteria infection who are treated with different dosages of teicoplanin and explore the necessity of reasonable delivery of teicoplanin for therapeutic drug concentration monitoring（TDM）.METHODS A total of 52 elderly patients with severe gram-positive bacteria infections who were treated in the hospital from Mar 2015 to Feb 2016 were enrolled in the study and divided into the observation group with 24 cases and the control group with 28 cases.The observation group was treated with 0.4g of intravenous drip of teicoplanin from Day 1to Day 3,once per 12 hours,and then was given 0.4g,once daily,intravenous drip;the control group was given the conventional dosage of 0.4g of teicoplanin on Day 1,once per 12 hours,intravenous drip,and then was treated with 0.4g,once daily,intravenous drip.The blood samples were collected during the treatment period,the Cmin of teicoplanin was determined,and the Cmin,effective rate of clinical treatment,bacterial clearance rate,and incidence of adverse reactions were observed and compared between the two groups of patients.RESULTS The Cmin of teicoplanin was（22.04±11.02）mg/l in the observation group,（13.62±2.66）mg/l in the control group;the effective rate of clinical treatment was 91.6%in the observation group,78.6%in the control group;the bacterial clearance rate was 87.5%in the observation group,71.4%in the control group;the incidence of adverse reactions was 8.3%in the observation group,3.6%in the control group;there was significant difference in the Cmin between the two groups of patients（P〈0.05）.CONCLUSIONThe initial use of highdose and maintenance dose of teicoplanin can achieve favorable effect on treatment of the elderly patients with severe gram-positive bacteria infections and meet the effective Cmin,without the increase of adverse reactions.It is suggested that the dosage of teicoplanin should be increased while theCmin of teicoplanin is monitored so as to raise the effective rate of teicoplanin.