万古霉素的临床药代动力学。

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Matzke GR, Zhanel GG, Guay DR

万古霉素的临床药代动力学。

临床药典杂志，1986 july - aug;11(4):257-82。doi: 10.2165 / 00003088-198611040-00001。

PubMed ID

3530582 (PubMed视图

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摘要

由于耐甲氧西林葡萄球菌感染的临床意义日益增加，万古霉素的使用在过去10年中急剧增加。最近的研究集中在描述万古霉素在患者中的处置特征和评估血清浓度与治疗和不良反应之间的关系。尽管万古霉素不能从完整的胃肠道中明显吸收，但最近的一些病例报告已经记录了口服万古霉素治疗性和潜在毒性的血清浓度给假膜性结肠炎患者。经静脉给药万古霉素的处置已被一个三指数模型最好地描述。在肾功能正常的受试者中，初始阶段(t1/2 pi)的半衰期约为7分钟，第二阶段(t1/2 alpha)的半衰期约为0.5至1小时，而最终消除半衰期(t1/2 beta)为3至9小时。成人中央室容积(Vc)约为0.15 L/kg，稳态分布容积(Vdss)为0.39 ~ 0.97 L/kg。超过80%的万古霉素剂量在给药后24小时内随尿液排出体外，据报道，肝组织和胆汁中的万古霉素浓度达到或低于检出限。万古霉素的肾脏清除率约为同时测定的肌酐或125I-iothalamate清除率的0.5 - 0.8，这表明肾脏排泄的主要途径是肾小球滤过。近年来，肝偶联等非肾因素被认为是消除万古霉素的重要途径。然而，这些数据很难与其他显示万古霉素在终末期肾病患者中非肾脏清除率极低的研究相一致。 As yet, the disposition of vancomycin in patients with hepatic disease has not been adequately defined. Only limited data are available regarding the concentrations of vancomycin in biological fluids other than plasma. The penetration of vancomycin into cerebrospinal fluid (CSF) in patients with and without meningitis has been quite variable. Although early studies suggested that adequate CSF concentrations may not be achieved in subjects with uninflamed meninges, more recent investigations have reported contradictory results. Therapeutic concentrations of vancomycin, i.e. greater than 2.5 mg/L, have, however, been reported in ascitic, pericardial, pleural and synovial fluids. Tissue concentrations of vancomycin have exceeded simultaneous serum concentrations in heart, kidney, liver and lung sp

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