萬古黴素(vancomycin)對於methicillin-resistant Staphylococcus(MRSA)引起的感染而言,經常是首選治療的藥物。為了避免萬古黴素的濫用,及確保病人接受合理及有效的藥物治療,本研究之目的在評估某醫學中心萬古黴素的使用情形。收集2 000年10月至12月所有使用萬古黴素的住院病患共48人,作回溯性的分析。使用萬古黴素的患者其年齡分佈60歲以上者佔了56.7 %(34人);在48人中,16人(33.3 %)為菌血症,其中11人(22.9%)為MRSA,另5人(10.4 %)為S. epidermidis。40人符合萬古黴素的合理性使用。在臨床監測指標中,79.1 %的病患在使用萬古黴素前,已做血清中肌酸酐(serum oreatinine ; Scr)的監測,而用藥過程中,病人接受血清中肌酸酐監測比率為64.6%;在治療結果方面,43.8 %(21人)在接受萬古黴素治療後,白血球的數目恢復正常的範圍內。另外,5人(10.4 %)在使用萬古黴素後腎功能變差,懷疑可能為藥物所引起的腎毒性併發症。
Vancomycin has been used with increasing frequency for the treatment of infections caused by the methicillin-resistant Staphylococcus aureus (MRSA). We conducted a retrospective study of the appropriateness of the vancomycin usage on 48 patients hospitalized between October and December, 2000, at a medical center in Taipei. Thirty-three of them had MRSA infections of blood (11), respiratory tract (7), wound (8), urinary tract (2), and multiple sites (5); 5 had methicillin-resistant S. epidermidis (MRSE) infections. Of the ten others, 2 had culture-negative infective endocarditis with history of allergy to beta-lactams; 3 had no growth in cultures; and 5 had growth of gram-negatives and were considered to have the drug used inappropriately. Average duration of the medication was 12.8 ± 12.3 days, with median of 10 days (range: 1- 48 days). Only 7 of them had the vancomycin serum level tested. Of the 43 patients who had good reasons to use the drug, 10 (32.6%) had negative conversion of the positive culture; and 24 (55.8%) required additional antibiotics. Twenty-one patients (48.8%) had normalization of the WBC after the therapy; 14 (32.6%) continued to have abnormal leukocyte count; 7 died; and 1 discharged in terminal condition. During the therapy, macular rashes developed in 4 (9.3%), drug fever in 2 (4.7%), and a rise in serum creatinine over 0.5 mg/dL in 5 (10.4%).
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