临床药师参与肾功能亢进患者万古霉素个体化用药的临床实践
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摘要
目的:探讨专业药师基于"精准药学"指导,在参与肾功能亢进患者万古霉素抗感染个体化用药中的作用。方法:临床药师参与3例肾功能亢进患者万古霉素个体化用药的剂量调整。基于"精准药学"指导,利用经典药动学软件(Vancomycin Calculator)联合JPKD-vancomycin群体药动学软件,协助医师完善治疗方案、监测不良反应、指导药物治疗方案调整。结果:通过预测万古霉素谷浓度,临床药师协助临床医师及时调整治疗方案,使稳态血药浓度维持在目标范围内,保证了疗效,同时加强监护可能发生的不良反应。结论:临床药师采用群体药动学方法参与万古霉素个体化用药,能提高万古霉素谷浓度达标率及临床疗效,为临床万古霉素的合理应用提供帮助。
Objective: To explore the role of occupational pharmacists involved in anti-infection individualized medication of vancomycin in the patients with augmented renal clearance based on "accurate pharmacy".Methods: Clinical pharmacists were involved in the dosage adjustment of individualized medication of vancomycin in 3 patients with augmented renal clearance.Based on "accurate pharmacy" and with the assistance of the classical pharmacokinetic software(Vancomycin Calculator) combined with JPKD-vancomycin population pharmacokinetics software, clinical pharmacists helped physicians to perfect treatment profiles, monitor adverse drug reactions(ADRs) and guide the adjustment of treatment profiles.Results: Through prediction of trough concentration of vancomycin, clinical pharmacists helped physicians to adjust treatment profiles, maintain stable serum drug concentration within the target range, ensure therapeutic effects, at the same time, intensify the monitoring of possible ADRs.Conclusion: By the way of population pharmacokinetics, clinical pharmacist involvement in individualized medication of vancomycin could increase the rates of reaching the standards of vancomycin trough concentration and clinical efficacy, and render pharmaceutical service in the rational use of vancomycin clinically.
Objective: To explore the role of occupational pharmacists involved in anti-infection individualized medication of vancomycin in the patients with augmented renal clearance based on "accurate pharmacy".Methods: Clinical pharmacists were involved in the dosage adjustment of individualized medication of vancomycin in 3 patients with augmented renal clearance.Based on "accurate pharmacy" and with the assistance of the classical pharmacokinetic software(Vancomycin Calculator) combined with JPKD-vancomycin population pharmacokinetics software, clinical pharmacists helped physicians to perfect treatment profiles, monitor adverse drug reactions(ADRs) and guide the adjustment of treatment profiles.Results: Through prediction of trough concentration of vancomycin, clinical pharmacists helped physicians to adjust treatment profiles, maintain stable serum drug concentration within the target range, ensure therapeutic effects, at the same time, intensify the monitoring of possible ADRs.Conclusion: By the way of population pharmacokinetics, clinical pharmacist involvement in individualized medication of vancomycin could increase the rates of reaching the standards of vancomycin trough concentration and clinical efficacy, and render pharmaceutical service in the rational use of vancomycin clinically.
引文
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[8] 唐莲,陆灏迪,薛盛敏,等.肾功能亢进患者万古霉素的药代动力学及谷浓度影响因素研究[J].国际医药卫生导报,2018,24(5):621-628.TANG Lian,LU Haodi,XUE Shengmin,et al.The influencing factors of pharmacokinetics of vancomycin and its trough concentration in patients with augmented renal clearance[J].Int Med Health Guid News,2018,24(5):621-628.In Chinese with English full text.
[9] Lodise T P,Lomaestro B,Graves J,et al.Larger vancomycin doses (at least four grams per day) are associted with an increased incidence of nephrotoxicity[J].Antimicrob Agents Chemother,2008,52(4):1330-1336.
[10] Nelson N R,Morbitzer K A,Jordan J D,et al.The impact of capping creatinine clearance on achieving therapeutic vancomycin concentrations in neurocritically ill patients with traumatic brain injury[J].Neurocrit Care,2019,30(1):126-131.
[11] 万古霉素临床应用剂量专家组.万古霉素临床应用剂量中国专家共识[J].中华传染病杂志,2012,30(11):641-646.Expert Group on Clinical Dosage of Vancomycin.Chinese expert consensus on the clinical dosage of vancomycin[J].Chin J Infect Dis,2012,30(11):641-646.In Chinese.
[12] De Waele J J,Dumoulin A,Janssen A,et al.Epidemiology of augmented renal clearance in mixed ICU patients[J].Minerva Anestesiol,2015,81(10):1079-1085.
[13] 陆灏迪,唐莲,薛盛敏,等.万古霉素群体药代动力学在肾功能亢进患者中的临床验证[J].中华危重病急救医学,2018,30(5):444-448.LU Haodi,TANG Lian,XUE Shengmin,et al.Clinical verification of vancomycin population pharmacokinetics in patients with augmented renal clearance[J].Chin Crit Care Med,2018,30(5):444-448.In Chinese with English abstract.
[2] Campassi M L,Gonzalez M C,Masevicius F D,et al.Augmented renal clearance in critically ill patients:incidence,associated factors and effects on vancomycin treatment[J].Rev Bras Ter Intensiva,2014,26(1):13-20.
[3] 何娟,毛恩强,景峰,等.重症急性胰腺炎伴肾功能亢进患者万古霉素的PK/PD研究[J].中华危重病急救医学,2017,29(9):810-814.HE Juan,MAO Enqiang,JING Feng,et al.PK/PD of vancomycin in patients with severe acute pancreatitis combined with augmented renal clearance[J].Chin Crit Care Med,2017,29(9):810-814.In Chinese with English abstract.
[4] 方洁,刘利艳,黄洁,等.优化万古霉素给药方案的研究[J].药学服务与研究,2017,17(3):179-182.FANG Jie,LIU Liyan,HUANG Jie,et al.Study on the optimization of dosage regimen of vancomycin[J].Pharm Care Res,2017,17(3):179-182.In Chinese with English abstract.
[5] Ishii H,Hirai K,Sugiyama K,et al.Validation of a nomogram for achieving target trough concentration of vancomycin:accuracy in patients with augmented renal function[J].Ther Drug Monit,2018,40(6):693-698.
[6] Bilbao-Meseguer I,Rodríguez-Gascón A,Barrasa H,et al.Augmented renal clearance in critically ill patients:a systematic review[J].Clin Pharmacokinet,2018,57(9):1107-1121.
[7] Kawano Y,Morimoto S,Izutani Y,et al.Augmented renal clearance in Japanese intensive care unit patients:a prospective study[J].J Intensive Care,2016,4:62.
[8] 唐莲,陆灏迪,薛盛敏,等.肾功能亢进患者万古霉素的药代动力学及谷浓度影响因素研究[J].国际医药卫生导报,2018,24(5):621-628.TANG Lian,LU Haodi,XUE Shengmin,et al.The influencing factors of pharmacokinetics of vancomycin and its trough concentration in patients with augmented renal clearance[J].Int Med Health Guid News,2018,24(5):621-628.In Chinese with English full text.
[9] Lodise T P,Lomaestro B,Graves J,et al.Larger vancomycin doses (at least four grams per day) are associted with an increased incidence of nephrotoxicity[J].Antimicrob Agents Chemother,2008,52(4):1330-1336.
[10] Nelson N R,Morbitzer K A,Jordan J D,et al.The impact of capping creatinine clearance on achieving therapeutic vancomycin concentrations in neurocritically ill patients with traumatic brain injury[J].Neurocrit Care,2019,30(1):126-131.
[11] 万古霉素临床应用剂量专家组.万古霉素临床应用剂量中国专家共识[J].中华传染病杂志,2012,30(11):641-646.Expert Group on Clinical Dosage of Vancomycin.Chinese expert consensus on the clinical dosage of vancomycin[J].Chin J Infect Dis,2012,30(11):641-646.In Chinese.
[12] De Waele J J,Dumoulin A,Janssen A,et al.Epidemiology of augmented renal clearance in mixed ICU patients[J].Minerva Anestesiol,2015,81(10):1079-1085.
[13] 陆灏迪,唐莲,薛盛敏,等.万古霉素群体药代动力学在肾功能亢进患者中的临床验证[J].中华危重病急救医学,2018,30(5):444-448.LU Haodi,TANG Lian,XUE Shengmin,et al.Clinical verification of vancomycin population pharmacokinetics in patients with augmented renal clearance[J].Chin Crit Care Med,2018,30(5):444-448.In Chinese with English abstract.