当前位置： SCI文献检索 > Infection and Drug Resistance期刊下所有文献 > A Systematic Review of Vancomycin Dosing in Patients with Hematologic Malignancies or Neutropenia.

A Systematic Review of Vancomycin Dosing in Patients with Hematologic Malignancies or Neutropenia.

Abstract：

Objective:To provide a comprehensive review of vancomycin dosing in patients with hematologic malignancies or neutropenia. Methods:PubMed, Embase and the Cochrane Library were searched through April 2, 2020. Original studies relevant to vancomycin dosing regimen in adults with hematologic malignancies or neutropenia were included. No restriction was applied in study design and language. A descriptive analysis was performed. Results:Twenty-three studies were included eventually, of which eighteen were case series studies, four were cohort studies and another one was a randomized controlled trial. Five case series studies made a clinical audit of conventional vancomycin dosing in patients with malignancies or neutropenia, showing that the proportion of patients with sub-therapeutic trough levels remained high, ranging from 32% to 88%. Seven case series studies and four cohort studies demonstrated that vancomycin clearance (CLva) tended to be higher in patients with hematologic malignancies or neutropenia, whereas volume of distribution (V) seemed to be comparable to the control group. Five studies proposed individualized initial dosing regimen per the pharmacokinetic changes; however, no prospective validation has been conducted in clinical setting. Additionally, four case series studies suggested that the correlation between vancomycin clearance and estimated creatinine clearance was relatively poor, bringing a great challenge to proper dosing strategy. A randomized controlled trial stated that therapeutic drug monitoring (TDM) of vancomycin could decrease the incidence of nephrotoxicity in immunocompromised febrile patients with hematologic malignancies. Conclusion:The available evidence indicates that conventional vancomycin dosing leads to suboptimal concentration in patients with hematologic malignancy or neutropenia. TDM accompanied by pharmacokinetic interpretation can decrease the risk of nephrotoxicity. The individualization of the initial dosing regimen and mechanisms of augmented clearance require further research.

journal_name

Infect Drug Resist

journal_title

Infection and drug resistance

authors

He N,Dong F,Liu W,Zhai S

doi

10.2147/IDR.S239095

subject

Has Abstract

pub_date

2020-06-16 00:00:00

pages

1807-1821

issn

1178-6973

pii

239095

journal_volume

13

pub_type

杂志文章,评审

相关文献

Infection and Drug Resistance文献大全