Exploration Of The Therapeutic Drug Monitoring Of Vancomycin And Target Treatment Concentration In The Pediaric

Objective:To explore the the distribution characteristics of vancomycin serum concentration and the target therapeutic concentration in pediatric Methods: A total of 59 children who were hospitalized and received intravenous vancomycin from the Shengjing Hospital affiliated to China Medical University from November 2017 to February 2019 were enrolled,including 21 patients with G+ cocci infection in the targeted treatment group,38 patients received vancomycin empiric therapy,Medication regimen: the initial dose was 10 mg/kg.times,the infusion time was 1h and Q6 h was administered.Among them,11 patients in the empiric treatment group,the monitoring dose was adjusted to 15 mg/kg.times,Q6 h,according to the initial serum concentration.the serum concentration were reached at steady state,the concentration of trough is at least half an hour before the fourth administration,and the peak concentration is collected at least 0.5-1 hour after the fourth administration,while avoiding collecting the serum samples on the infusion Infusion vein,collecting2 ml venous blood samples,sentingd to the pharmacy department of the hospital for testing.The data were analyzed by SPSS 24.0 software.The factors affecting the initial trough concentration were analyzed by single factor and multi-factor.The target treatment concentration was obtained by analyzing the serum drug concentration of the treatment group.Result:There was a linear relationship between the initial trough concentration and the peak concentration,and the equation was Cmax=3Cmin(r=0.604,P<0.05).There were differences with serum concentration distribution between different age groups of children,but there was no statistical significance.The initial trough concentrations of the critical-illed were significantly higher than that of the non-critical recombination(P<0.01).The initial trough and peak concentrations in the septic shock group were significantly higher than those in the non-septic shock group(P<0.05).The initial trough concentrations in the congenital heart disease group was significantly higher than that in the non-congenital heart disease group(P<0.01).The initial trough concentrations in patients with abnormal liver and kidney function were significantly higher than that in normal liver and kidney function group(P<0.05).Theinitial trough concentrations in the urine pH-acidified group were significantly higher than that in the urine PH-basic group(P<0.05).The initial trough and peak concentrations of the patients with severe low albumin were higher than those of the children with non-severe low albumin.There was no significant difference in serum concentration distribution between different IgA levels,whether using mechanical ventilation,special physical cooling,intravenous nutrition,and diuretics.There were no significant differences in the trough concentrations between the 11 patients who received dose adjustments between the others who got unchanged treatment.(P=0.182),but the peak concentration distribution was significantly different between them(P=0.006).At the same time,the blood concentrations of 8children with diarrhea were observed to be higher than the average drug concentration of others at the same age,teated with the same dose.Through the step-by-step method,multiple linear regression analysis was performed on the factors influencing the initial blood concentration.The independent variables in the final equation were criticality,septic shock,congenital heart disease,albumin,and urine PH.By using the drug concentration of the treatment group to make the ROC curve,we found that the optimal trough concentration was 7.120ug/mL,and the optimal peak concentration was 29.325 ug/mL.Conclusion:The blood concentration of vancomycin was significantly different among children with different severity,different disease types and different physical constitutions.For diseases that are extremely critical,severely infected with septic shock,congenital heart disease,moderate to severe diarrhea,etc.,which cause insufficient circulation of blood circulation,abnormal hemodynamics,and factors affecting drug body binding and excretion such as low albumin and low IgA levels.The plasma concentrations of children with abnormal liver and kidney function before treatment were generally high.The higher the serum concentrations were,the more likely it were to be clinically effective.However,when there is circulatory dysfunction in severe infection,the drug distribution is abnormal and the excretion is decreased.Under normal administration,the blood drug concentration may be high.The dose of the drug may cause accumulation of the drug in the body and increase the occurrence of adverse reactions.