PDF(Pubmed)
Abstract：
Augmented renal clearance (ARC), defined as a creatinine clearance (CrCl) > 130 mL/min/1.73 m2, is observed in 30-65% of critically ill patients. When following standard dosage guidelines, patients with ARC often experience subtherapeutic vancomycin levels, resulting in treatment failure due to accelerated drug elimination. This review aims to explore ARC\'s impact on vancomycin pharmacokinetics and pharmacodynamics (PK/PD) indices in ARC patients, seeking to identify an accurate dose adjustment method for this patient population. In September 2023, a comprehensive literature search was conducted on the MEDLINE and EMBASE databases to include all available studies providing information on the impact of ARC on vancomycin therapy in critically ill adults. Articles that studied the pediatric population and those with insufficient PK data were excluded. A total of 21 articles met the inclusion criteria. The findings revealed a positive correlation between CrCl and vancomycin clearance, indicating low serum concentrations. Therefore, upward dosing adjustments are necessary to improve treatment success. Younger age consistently emerged as a major contributor to ARC and vancomycin PK/PD alterations. This study summarizes the PK/PD alterations, current dosage recommendations and proposes preliminary recommendations on possible dosing approaches to decrease the risk of subtherapeutic exposure in this patient population.
摘要：
增强肾清除率（ARC），定义为肌酐清除率（CrCl）>130mL/min/1.73m2，在30-65％的危重患者中观察到。当遵循标准剂量指南时，ARC患者经常经历亚治疗万古霉素水平，由于加速药物消除而导致治疗失败。本文旨在探讨ARC对ARC患者万古霉素药代动力学和药效学(PK/PD)指标的影响。寻求为该患者人群确定一种准确的剂量调整方法。2023年9月，在MEDLINE和EMBASE数据库上进行了全面的文献检索，以包括所有可用的研究，这些研究提供了有关ARC对重症成人万古霉素治疗影响的信息。排除了研究儿科人群和PK数据不足的文章。共有21条符合纳入标准。研究结果表明CrCl与万古霉素清除率呈正相关，表明血清浓度低。因此,上调剂量是提高治疗成功率所必需的.年轻的年龄始终成为ARC和万古霉素PK/PD改变的主要原因。本研究总结了PK/PD改变，目前的剂量建议，并就可能的给药方法提出初步建议，以降低该患者人群亚治疗暴露的风险。
