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 minim...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.展开更多
目的:全面了解抗真菌药物治疗药物监测的研究进展,为临床合理应用抗真菌药物提供参考,确保患者用药安全。方法:英文检索Pub Med、Embase、Web of Science数据库;中文检索Sino Med关于抗真菌药物的治疗药物监测的文献,检索时间为1985年–...目的:全面了解抗真菌药物治疗药物监测的研究进展,为临床合理应用抗真菌药物提供参考,确保患者用药安全。方法:英文检索Pub Med、Embase、Web of Science数据库;中文检索Sino Med关于抗真菌药物的治疗药物监测的文献,检索时间为1985年–2014年。利用End Note X5及人工双重进行分类整理,用Excel表对最终纳入的文献建立评价数据库。分析文献发表的年代、作者、期刊、影响因子、研究机构、被引频次和研究方法,归纳文献涉及抗真菌药物与处理措施。结果:共检索出英文文献359篇,中文29篇。英文数据库检出文献:Pub Med 76篇,Embase 224篇,SCI 59篇;中文数据库检出文献:Sino Med 29篇。经End Note X5和双人手工去除重复文献,按入排标准,最终得到226篇文献。其中,英文文献220篇,中文文献6篇。2004–2014年文献量增加较快,近年来随着抗真菌药物的广泛应用,抗真菌药物的治疗药物监测也逐渐引起重视。纳入研究的文献类型有论著、综述、回顾性分析、病例分析、会议等。结论:由于抗真菌药物在临床应用过程中存在个体差异大和联合用药时易出现不良反应等情况,国内外已对抗真菌药监测加大了关注度。展开更多
Polymyxin B,which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections,became available in China in Dec.2017.As dose adjustments are based solely on clinical experience of risk t...Polymyxin B,which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections,became available in China in Dec.2017.As dose adjustments are based solely on clinical experience of risk toxicity,treatment failure,and emergence of resistance,there is an urgent clinical need to perform therapeutic drug monitoring(TDM)to optimize the use of polymyxin B.It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use.We report a consensus on TDM guidelines for polymyxin B,as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society.The consensus panel was composed of clinicians,pharmacists,and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations,sample collection,reporting,and explanation of TDM results.The guidelines provide the first-ever consensus on conducting TDM of polymyxin B,and are intended to guide optimal clinical use.展开更多
文摘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.
文摘目的:全面了解抗真菌药物治疗药物监测的研究进展,为临床合理应用抗真菌药物提供参考,确保患者用药安全。方法:英文检索Pub Med、Embase、Web of Science数据库;中文检索Sino Med关于抗真菌药物的治疗药物监测的文献,检索时间为1985年–2014年。利用End Note X5及人工双重进行分类整理,用Excel表对最终纳入的文献建立评价数据库。分析文献发表的年代、作者、期刊、影响因子、研究机构、被引频次和研究方法,归纳文献涉及抗真菌药物与处理措施。结果:共检索出英文文献359篇,中文29篇。英文数据库检出文献:Pub Med 76篇,Embase 224篇,SCI 59篇;中文数据库检出文献:Sino Med 29篇。经End Note X5和双人手工去除重复文献,按入排标准,最终得到226篇文献。其中,英文文献220篇,中文文献6篇。2004–2014年文献量增加较快,近年来随着抗真菌药物的广泛应用,抗真菌药物的治疗药物监测也逐渐引起重视。纳入研究的文献类型有论著、综述、回顾性分析、病例分析、会议等。结论:由于抗真菌药物在临床应用过程中存在个体差异大和联合用药时易出现不良反应等情况,国内外已对抗真菌药监测加大了关注度。
基金the Shanghai Leading Talents Award,Shanghai Municipal Health Commission(No.LJ2016-01)the Clinical Research Plan of Shanghai Hospital Development Center(No.SHDC2022CRW004)。
文摘Polymyxin B,which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections,became available in China in Dec.2017.As dose adjustments are based solely on clinical experience of risk toxicity,treatment failure,and emergence of resistance,there is an urgent clinical need to perform therapeutic drug monitoring(TDM)to optimize the use of polymyxin B.It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use.We report a consensus on TDM guidelines for polymyxin B,as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society.The consensus panel was composed of clinicians,pharmacists,and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations,sample collection,reporting,and explanation of TDM results.The guidelines provide the first-ever consensus on conducting TDM of polymyxin B,and are intended to guide optimal clinical use.
