我们在一起更好吗? 通过混合的AUC和基于低谷的剂量指南来减少万科米辛的使用和急性损伤
Alyssa Christensen1, Ethan Ryberg1, Zachary Nelson1
1HealthPartners and Park Nicollet Health Services, Minneapolis, Minnesota, USA.
Pharmacotherapy
|March 24, 2025
概括
一种混合的范胺剂量策略,包括曲线下面面积 (AUC) 和低谷监测,减少范胺剂量,血清水平和急性损伤 (AKI). 与统一的AUC剂量相比,这种方法也为药剂师节省了大量的时间和成本.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 传染性疾病 传染性疾病
- 临床药房 临床药房
背景情况:
- 目前的范科米辛指南建议对严重的甲素耐药黄金葡萄球菌 (MRSA) 感染进行曲线下面面积 (AUC) 监测.
- 对于非严重的葡萄球菌或其他格拉姆阳性感染,没有具体的建议,并且AUC监测可能是资源密集的.
- 对所有患者的基于AUC的万科米辛剂量的必要性是可疑的.
研究的目的:
- 评估新的机构指导方针对米素剂量对累积剂量,血清水平和急性损伤 (AKI) 的影响.
- 评估与混合剂量方法相关的药剂师时间和成本的潜在节省.
主要方法:
- 在2023年在八家医院系统中实施了对万科米辛剂量 (AUC或低谷) 的新机构指南.
- 追溯比较成人患者接触 (n=8155) 6个月前后实施.
- 在子组中评估累计的万科米辛剂量,剂量,血清水平和AKI率;估计药剂师的时间节省.
主要成果:
- 实施后的组显示了显著较低的累计中位数万科米辛剂量 (2500毫克 vs 3000毫克) 和较少的血清水平.
- 一项小组分析显示,在实施后,AKI率显著下降 (7.2%与9.6%相比).
- 估计药剂师节省的时间从2229分钟到5201分钟不等,相当于6个月的16851美元到39319美元.
结论:
- 一种混合的万科米辛剂量方法,主要是基于AUC,对不太严重的感染进行了低谷考虑,有效地降低了万科米辛剂量,血清水平和AKI.
- 与统一的AUC剂量政策相比,这种方法显著节省了药剂师的时间和相关成本.
- 这些发现表明大量的不必要的万科米辛使用,并强调了量身定制的剂量策略的好处.
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