万古霉素是从链霉菌中分离得到的糖肽类抗生素，至今仍是治疗耐甲氧西林葡萄球菌的首选药物。万古霉素代谢个体差异显著，仅通过药物说明书和医师经验性用药，对于重症及复杂感染患儿很难使血药浓度达到目标范围（15~20 mg/L），必须借助万古霉素血药浓度监测（TDM），利用群体药代动力学/药效学（PK/PD）模式，通过贝叶斯（Bayes）反馈获得个体PK/PD参数来实施精细调控。文章从万古霉素当前临床用药指南拓展到最新研究理论，充分显示肾功能、体质量、年龄、疾病状态是影响儿童万古霉素代谢效应的主要参数；且血药浓度-时间曲线下面积/最小抑菌浓度（AUC/MIC）≥400为更佳的监测效应值。%e: Vancomycin is a glycopeptide antibiotic separated from streptomycete, having been used as the ifrst choice to treat methicillin-resistant Staphylococcus aureus infection so far. The studies show that because of the individual difference in the metabolism of vancomycin, it is dififcult to get the trough concentration of pediatric patients severely ill or complicatedly in-fected to reach the target range (15—20 mg/L). However, with the help of therapeutic drug monitoring (TDM) of vancomycin and the pharmacokinetic/pharmacodynamic parameter (PK/PD) mode, the PK/PD parameters to achieve the precise control can be acquired by using the Bayes feedback. By a stretched review from clinical medication guide of vancomycin to the latest evidence from research, this paper fully demonstrates that renal function, weight, age, and disease state are the principal parameters to impact pediatric patient’s vancomycin metabolism and that the area under the concentration-time curve divided by the minimum inhibitory concentration (AUC/MIC)≥400 is the better cut-off value to determine vancomycin efifcacy and toxicity.
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