谨慎处理报告的抗生素过敏是抗生素管理的一个重要方面。荷兰抗生素政策工作组（SWAB）于2023年4月发布了《SWAB指南：疑似抗生素过敏的处理方法》以下简称（指南）,指南依据对疑似抗生素过敏人群的比较和结果问题研究,对每个问题进行系统的文献检索,并通过证据评价系统对现有最佳证据进行审查后制定。指南就疑似抗生素交叉过敏,速发型过敏和迟发型过敏等问题进行阐述,为报告抗生素过敏患者选用抗生素治疗的床旁决策提供基于现有研究的循证建议。本文对指南涉及12个关键问题进行解读,以期为疑似抗生素过敏患者临床治疗提供参考,使患者获益。

Careful handling of reported antibiotic allergies is an important aspect of antibiotic management．In April 2023,the Dutch Working Group on Antibiotic Policy（SWAB）issued the SWAB Guide：“The Dutch Working Party on Antibiotic Policy（SWAB）guideline for the approach to suspected antibiotic allergy”,hereinafter referred to as “the guide”．According to the intervention,comparison and results of people with suspected antibiotic allergy,the guide systematically searched the literature of each question,and was formulated after reviewing the best evidence available through the evidence evaluation system．The guide elaborated on the suspected cross-allergy,quick-onset allergy and delayed-onset allergy,and selected antibiotics for reporting patients with antibiotic allergy．In this paper,12 key issues involved in the guidelines are interpreted in order to provide reference for clinical treatment of patients suspected of antibiotic allergy and benefit patients．

目的 为临床合理使用替考拉宁以及更好地管理接受替考拉宁治疗的患者。方法 从药学角度对2022年日本《2022 JSC/JSTDM临床实践指南:替考拉宁治疗药物监测》(简称《指南》)涉及替考拉宁治疗的9个临床问题进行解读。结果 《指南》指出药-时曲线下面积/最小抑菌浓度是替考拉宁的关键药动学/药效学参数。替考拉宁治疗药物监测(TDM)的目的是明确目标谷浓度(C_min),对于严重或复杂的耐甲氧西林金黄色葡萄球菌(MRSA)感染,指南建议替考拉宁C_min为20~40 mg/L。肾功能正常或轻度受损的非复杂性的MRSA感染,目标C_min为15~30 mg/L。严重和/或复杂性MRSA感染,如感染性心内膜炎和骨髓炎,替考拉宁C_min为20~40 mg/L。结论 《指南》针对不同病理状态下患者替考拉宁目标C_min的确定,为临床治疗中替考拉宁TDM、个体化给药提供参考。

Objective To make rational use of teicoplanin and better management of patients treated with teicoplanin. Methods Nine clinical issues related to the treatment of teicoplanin in Clinical practice guidelines for therapeutic drug monitoring of teicoplanin: a consensus review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring (Japan, 2022) were interpreted from the perspective of pharmacy. Results The guidelines indicated that the area under drug-time curve/minimum inhibitory concentration was the key pharmacokinetic/pharmacodynamic parameters of teicoplanin.The purpose of therapeutic drug monitoring (TDM) of teicoplanin is to specify the target trough concentration (C_min), which guidelines recommend for severe or complex methicillin-resistant Staphylococcus aureus (MRSA) infection is 20-40 mg/L.The target C_min for uncomplicated MRSA infection with normal or mildly impaired renal function is 15-30 mg/L.For severe and/or complex MRSA infections, such as infective endocarditis and osteomyelitis, the C_min of teicoplanin was 20-40 mg/L. Conclusions The guidelines are aimed at the determination of target C_min of teicoplanin in patients with different pathological conditions, and provide reference for individual drug administration and teicoplanin TDM in clinical treatment.