Optimal Teicoplanin Trough Concentration With Therapeutic Drug Monitoring in Children: A Systematic Review and Meta-analysis

医学 替考拉宁 置信区间 优势比 槽浓度 肾毒性 治疗药物监测 槽水位 荟萃分析 内科学 胃肠病学 万古霉素 毒性 药代动力学 金黄色葡萄球菌 细菌 生物 他克莫司 遗传学 移植
作者
Yuki Hanai,Kazutaka Oda,Takashi Ueda,Kazuaki Matsumoto,Lisa Murakami,Shusuke Uekusa,Hayato Ohashi,Koji Nishimura,Yoshio Takesue,Kazuhiro Matsuo
出处
期刊:Therapeutic Drug Monitoring [Lippincott Williams & Wilkins]
卷期号:46 (6): 699-709 被引量:1
标识
DOI:10.1097/ftd.0000000000001230
摘要

Background: Teicoplanin is used to treat serious Gram-positive bacterial infections. However, the optimal trough concentrations for pediatric patients remain unclear owing to the lack of monitoring guidelines. This study aimed to determine the optimal teicoplanin trough concentration for treating Gram-positive bacterial infections in children. Methods: A systematic review was conducted using 4 databases. Stepwise cutoffs within the range of 10–30 mcg/mL were used for efficacy and safety. Studies were included if they reported treatment success rates and/or all-cause mortality, nephrotoxicity, hepatotoxicity, and thrombocytopenia according to the trough concentration. Results: The meta-analysis included 12 studies involving 830 pediatric patients. Teicoplanin cutoff values of 10, 15, 20, and 30 mcg/mL were reported in 9, 8, 9, and 2 studies, respectively. Trough concentrations <10 mcg/mL significantly reduced the treatment success rate, with an odds ratio of 0.07 and a 95% confidence interval ranging from 0.01 to 0.40. The overall treatment success rate was 50.0% versus 95.7% observed at concentrations ≥10 mcg/mL. However, no significant difference was observed at the 15-, 20-, and 30-mcg/mL cutoffs, when compared with lower concentrations. Trough concentrations <20 mcg/mL were associated with a decreased risk of nephrotoxicity (odds ratio = 0.21; 95% confidence interval, 0.08–0.55). However, hepatotoxicity and thrombocytopenia showed no significant associations with trough concentration ranges between 10 and 30 mcg/mL. Conclusions: Although further prospective studies are required for validation, the authors' findings suggest that 10- to 20-mcg/mL teicoplanin is the optimal trough concentration for enhanced clinical success and reduced toxicity in pediatric patients.
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