中風病人與照護者於健康相關生活品質評量之一致性

Vancomycin 為治療methicillin-resistant Staphylococcus aureus 的首選用藥，隨著近年MRSA 比例上升，如何使vancomycin 達到最佳的給藥方式和減少毒性及抗藥性的產生越來越受到重視。有學者認為，單獨以波谷濃度去評估vancomycin 給藥是否適當是有待商榷的。而抗生素的藥物動力學/藥效學（pharmacokinetics/pharmacodynamics; PK/PD） 理論應用是近年來重要的研究方向，但在臨床上究竟應該以何種藥物動力學/藥效學指標代表vancomycin 的臨床治療效果，目前仍有相當多的討論，當前普遍認為以time above MIC（T > MIC）與area under inhibitory curve（AUC/MIC、AUIC）二者為主。其中若以目前體內和臨床試驗資料顯示，AUC/MIC ≥ 400 μg-hr/mL 可視為vancomycin 給藥治療之重要目標，2010 年美國國家衛生研究院（NIH）評估過後亦已視AUC/MIC 為預測vancomycin 治療效果最有效的藥物動力學/藥效學指標。對於vancomycin 的臨床藥動/藥效學評估，還有兩個相關議題尚待研究；第一，AUC/MIC≥ 400 μg-hr/mL的資料是來自於下呼吸道感染的病患，是否這個數值可以用來評估其他不同類型的感染並不清楚，還有待更多的臨床研究來證實。第二，雖然AUC/MIC 為最佳vancomycin 藥物動力學/藥效學指標，但並不表示vancomycin 不是time- dependent 殺菌型抗生素，而是由於vancomycin 還有較長的抗生素後效應，故對於藥理機轉上混合有time-與concentration-dependent 特性的抗生素來說，是否可以廣泛運用AUC/MIC 這個藥物動力學/藥效學指標亦值得做更進一步的研究。

Vancomycin is remained a mainstay for the treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In recent years, the proportion of MRSA occurrence has raised. How to achieve the optimal vancomycin dosing regimen, reducing the side effect and drug resistance has been gaining more and more attentions. Some authors consider evaluating troughs alone a suboptimal method of assessing the adequacy of a vancomycin dose. Application of antibiotics' pharmacokinetics/pharmacodynamics (PK/PD) becomes a very important research in recent years. However, in clinical practice, what exactly should be representative of PK/PD parameter target treatment effect is still unknown. At present, time above MIC (T>MIC) and area under inhibitory curve (AUC/MIC、AUIC) are both the widely used indicators of treatment. But among these in vivo and clinical outcomes data have proven the utility of an AUC/MIC of 400 μg-hr/mL or greater, it is strongly recommended that an estimation of the AUC be performed as the primary method for clinically evaluating the optimal vancomycin dosing regimen for patients. In 2010, National Institutes of Health (NIH) acknowledges that the ratio of the area under the curve to the MIC (AUC/MIC) is likely the most useful PK/PD parameter for predicting vancomycin efficacy. Two points must be considered from these data. First, the AUC/MIC of 400μg-hr/mL or greater was derived from patients with lower respiratory tract infections, and it is unclear if this value should be used for other infections. However, this could be a starting point for future clinical outcome evaluations. Second, although AUC/MIC is the best PK/PD predictor of a good clinical outcome, this does not mean that vancomycin does not demonstrate time-dependent killing. Because vancomycin has a post-antibiotic effect along with time-dependent killing, further researches are necessary to prove whether the AUC/MIC can be widely used in clinical practice as a pharmacodynamic indicator.