腹腔内投与のヴァンコミシンは,PDに関連した腹腔炎の患者で,血清と腹腔内流体における薬剤濃度が最適以下である
Ezhilnilavan Sampath1, Kapil Navin Sejpal2, Apurba S Sastry3
1Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), JIPMER Campus, Puducherry, India.
Indian journal of nephrology
|September 2, 2025
まとめ
腹腔内透析内膜炎の治療には,96時間ごとに15mg/ kgの腹腔内透析内膜炎は不十分である. ほとんどの患者は治療的なバンコミシン血清濃度に達せず,投与量の調整とさらなる薬動学的研究が必要となった.
科学分野:
- 腎臓科
- 薬理学
- 感染症
背景:
- 腹腔内透析 (PD) に関する腹腔内炎の標準治療法である.
- 慢性腎臓病 (CKD) の患者のバンコミシン投与量を最適化することが重要です.
- この研究では,常用投与方式を用いて,PD患者におけるバンコミシン血清濃度が調査されました.
研究 の 目的:
- 標準の腹腔内バンコミシン投与量で,腹腔炎のPD患者の治療用血清濃度が達成されるかどうかを評価する.
- 末期腎疾患 (ESRD) の患者でバンコミシン投与の適切性を評価する.
主な方法:
- PDに関連した腹膜炎の41エピソードの薬理学分析.
- 患者は,腹膜内投与のバンコミシン15 mg/ kgを96時間ごとに投与された.
- 血清と透析液のバンコミシン濃度は,液体染色体-タンデム質量スペクトロメトリを用いて測定された.
主要な成果:
- 推奨される低血清バンコマイシン濃度 (> 15 mg/ L) を達成したエピソードは41件のうち2件のみでした.
- 標準的な投与法は,PD 炎のほとんどの症例で治療的なバンコマイシン濃度に達しなかった.
- 21回の症例では PD カテーテルを摘出する必要があり 治療に問題があることが示されました
結論:
- 断続的な腹腔内ヴァンコミシン (15 mg/ kg Q96H) は,PDに関連する腹腔炎の治療レベルを達成するのに不十分です.
- PD患者における抗生物質投与の指針として,薬理学的な研究が必要である.
- 現在の投与戦略は,治療の有効性と結果を改善するために改定する必要があります.
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