3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。noteもあります https://note.com/twin1980

Continuous Versus Intermittent Vancomycin Infusions in Infants: A Randomized Controlled Trial.

Pediatricsに報告された、新生児に対するVCMの持続投与についての2施設RCT。

 

www.ncbi.nlm.nih.gov

感想

 

新生児に対して、VCM持続投与は検討できるかも。

 

 

アウトカムは、定常状態における目標血中濃度到達率など真のアウトカムではないのですが、CI療法に有利な結果。

CI療法は、マンパワーに悩む看護師さんにファンが多い印象。

新生児科の医師とも議論を進めたい。

  • continuous infusions of vancomycin (CIV)
  • intermittent infusions of vancomycin (IIV)

 

なお、ペニシリンG 持続投与 (CI) 療法は、私の思いが強く、大人の患者さんに対してめちゃ推していて、当院では結構動いています。

 

Abstract


BACKGROUND:

In adults, continuous infusions of vancomycin (CIV) are associated with earlier attainment of target drug concentrations, require fewer blood samples for monitoring, and may reduce drug toxicity. We aimed to determine, in young infants, if CIV or intermittent infusions of vancomycin (IIV) better achieves target vancomycin concentrations at the first steady-state level and to compare the frequency of drug-related adverse effects.

 

METHODS:

In a multicenter randomized controlled trial in 2 tertiary neonatal units over a 40-month period, young infants aged 0 to 90 days requiring vancomycin therapy for at least 48 hours were randomly assigned to CIV and IIV.

 

RESULTS:

Of 111 infants randomized, 104 were included in the intention-to-treat analysis. Baseline characteristics were similar for both groups. The proportion of infants achieving target concentrations at the first steady-state level was higher for CIV compared with IIV (45 in 53 [85%] vs 21 in 51 [41%]; P < .001). Fewer dose adjustments were required in the CIV group (median 0; range 0-1) compared with the IIV group (median 1; range 0-3; P < .001). The mean daily dose required to achieve target concentrations was lower with CIV compared with IIV (40.6 [SD 10.7] vs 60.6 [SD 53.0] mg/kg per day, respectively; P = .01). No drug-related adverse effects occurred in either group.

 

CONCLUSIONS:

In young infants, CIV is associated with earlier and improved attainment of target concentrations compared with IIV. Lower total daily doses are required to achieve target levels with CIV. There is no difference in the rate of drug-related adverse effects.

 

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02210169.

 

 

www.ncbi.nlm.nih.gov

 

小児感染症のトリセツREMAKE

小児感染症のトリセツREMAKE