Gentamicin monitoring practices in teaching hospitals – time to undertake the necessary randomised controlled trial

Martin, Jennifer, Barras, Michael, Yui, Nicholas Ah, Kirkpatrick, Carl, Kubler, Paul and Norris, Ross (2012) Gentamicin monitoring practices in teaching hospitals – time to undertake the necessary randomised controlled trial. Journal of Clinical Toxicology, 2 8: 146.1-146.5. doi:10.4172/2161-0495.1000146

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Author Martin, Jennifer
Barras, Michael
Yui, Nicholas Ah
Kirkpatrick, Carl
Kubler, Paul
Norris, Ross
Title Gentamicin monitoring practices in teaching hospitals – time to undertake the necessary randomised controlled trial
Journal name Journal of Clinical Toxicology   Check publisher's open access policy
ISSN 2161-0495
Publication date 2012
Sub-type Article (original research)
DOI 10.4172/2161-0495.1000146
Open Access Status DOI
Volume 2
Issue 8
Start page 146.1
End page 146.5
Total pages 5
Place of publication Los Angeles, CA, United States
Publisher OMICS Publishing Group
Collection year 2013
Language eng
Formatted abstract
Objective: To compare the clinical appropriateness of the prescribing and monitoring of gentamicin.
Method: A retrospective study was undertaken at two tertiary teaching hospitals in Australia. 161 adult patients
administered gentamicin and who had at least one serum concentration taken whilst an inpatient were eligible for
analysis.
The main outcome measures were adherence to local and national guidelines for dosing and monitoring of
gentamicin, and percentage of the recommended measure of adequate gentamicin exposure (Area-Under the
concentration-time Curve (AUC)) using a nomogram and a Bayesian calculation.
Results: Results were similar in both hospitals.
Initial dosing: Adherence to local and national dosing guidelines was poor - approximately 50% of initial doses
using less than local and 88% less than national recommendations.
Monitoring: Approximately 20% of all gentamicin concentrations were collected outside the required sampling
window. Sampling was particularly problematic after the initial dose. Here up with to half of the samples were taken
outside the recommended time frame for sampling, therefore making interpretation of the nomogram difficult.
Dose adjustment: 15% of doses were adjusted without monitoring and approximately half of all dose adjustments
were based on inadequate information or inaccurate nomogram interpretation.
Dose evaluation: Approximately half of the AUCs were below the therapeutic range.
Conclusion: A large number of issues around appropriate use and monitoring of gentamicin were seen. This is
particularly concerning considering both hospitals are large tertiary hospitals with expert clinical pharmacy support.
We believe it is time for a randomised controlled trial to be undertaken, comparing Bayesian modelling techniques
with standard nomogram, powered for clinical endpoints.
Keyword Gentamicin
Therapeutic drug monitoring
TCI works
Adherence
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article # 146

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
School of Pharmacy Publications
UQ Diamantina Institute Publications
 
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Created: Mon, 19 Nov 2012, 13:14:57 EST by Dr Jennifer Martin on behalf of UQ Diamantina Institute