| Background:Vancomycin is a sugar peptide antibiotic, which inhibits the synthesis of bacterial cell walls. In recent years, due to the widespread and unreasonable usage of antibiotics in clinic, the conditions of methicillin-resistant staphylococcus aureus (MRSA) and methicillin-resistant epidermis staphylococcus (MRSE) became more challenging. As the first choice antibiotic in severe infection, vancomycin was pushed to the focus. Because of narrow therapeutic drug concentration, individual differences, in vivo influence factors, and side-effects of earand kidney, its concentration monitoring is pivotal for patients undergoing vancomycin treatment.Objective:By the vancomycin for medicine dose and different methods to analyze the blood medicine valley concentration and the effect of treatment of severe sepsis clinical curative effect.Method:Use the prospective study method to collect 52 patients from PICU in Children’s Hospital of Zhejiang University from May 2013 to November 2015, diagnosed of gram-positive bacteria infection in severe sepsis in children, and pretreated with three different doses of vancomycin:Group A with 18 cases received vancomycin by the dose as 15mg/(kg·time), q8h; average age was 3.4±2.11years, average 13.15±10.13kg weight, sex tatio of male:female 5:4; Group B with 20 cases received vancomycin by the dose as 15mg/(kg·time), q8h after the first dose of 30 mg/kg; average age was 3.02±2.09years, average 14.27±12.16kg weight, sex tatio of male:female 11:9; Group C with 14 cases received vancomycin by the dose as 15mg/(kg·time), q6h; average age was 3.03±2.02years, average 13.78±11.22kg weight, sex tatio of male:female 1:1; each delivery time is more than 1 h. Using enzyme amplified immunoassay to (Emit) monitor blood concentration of vancomycin in the valley with venous blood after the four times,and 30 minutes before the 3、7day of delivery. Before, and after the 3-.7day of delivery, routine blood, double blood culture, CRP and PCT, the function of liver and kidney were detected (5 days review blood cultures).All the content was approved by the patients’parents and the Ethics Committee of Children’s Hospital of Zhejiang University School of Medicine. We did obtain informed and written consent from the next of parents on the behalf of the children participants involved in our study, and the consents were documented in the hospital computer system.Results:Compared with Group A, the time of achieving effective valley concentration in Group B and group C is shorter (A:3.1±1.23day, B:1.2±0.21day, C:2.14±0.86day), with significant differences (P<0.05). And the time of Blood culture turning is shorter (Group B and C in the 5th days, but the rate of bacteria positive was39.9% in Group A in the same time), with significant differences (P<0.05). Compared three Groups, white blood cells decline rate, liver and kidney funcition change is no statistical significance (P>0.05).Conclusion:Through this article research suggests the use of vancomycin drugs after the first dose of 30 mg/kg dose of 15 mg/kg/times (q8h) and 15 mg/kg/times (q6h) than 15 mg/kg/times (q8h) valley of effective concentration time early, and curative effect best, at the same time after the first dose of 30 mg/kg 15 mg/kg/times (q8h) curative effect after a slightly better than 15 mg/kg/times (q6h). Keep the level of vancomycin valley range in the valley of 10-20 mg/L, its clinical curative effect obviously, And there is no obvious function of liver and kidney damage and other side effects. |
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