DISCUSSION
Antibiotic concentration in pancreas tissue is very important for the
treatment of SAP patients with infections. Previous studies show that
quinolones and carbapenems have high pancreatic tissue levels and
aminoglycosides fail to penetrate into the pancreas in sufficient tissue
concentrations[22-25]. However, there are limited data with respect
to vancomycin. This case indicated the good penetration ability of
vancomycin in human pancreatic tissue, which provides evidence for the
prescription of vancomycin in SAP patients.
This result was inconsistent with another published animal
study[29], which concluded only 9% of vancomycin can penetrate into
pancreas tissue. The reason may be the difference between human and
animal studies or the difference of concentration between drainage and
tissue. Besides, it can also be explained as the increased permeability
to pancreas tissue of vancomycin under the pathological inflammation
state[30].
As for the dosage regimen, only renal function was considered for this
patient. Twice measured trough steady state concentration was 11.9
mg·L-1 and 15.7
mg·L-1 respectively, which were within the therapeutic
window of 10-20 mg·L-1[19].
AUC0-24h was three times of 154, which was also during
the range of 400-600 recommended as the
pharmacokinetics/pharmacodynamics target of vancomycin[20]. And the
patient’s outcome was good. As a consequence, the dosage regimen for
this patient was acceptable.
A previous study of the pharmacokinetics of vancomycin in patients with
SAP[31] shows the trough concentration is relatively low, and the
clearance is relatively high. However, the clearance (Table 1) of this
patient is similar to the description of vancomycin pharmacokinetics
characteristic in package insert[32]. But the pharmacokinetic
parameters need to be validated with more future studies since we only
have one patient.