Standard dosing of amikacin and gentamicin in critically ill patients results in variable and subtherapeutic concentrations

Roger, Claire, Nucci, Bastian, Molinari, Nicolas, Bastide, Sophie, Saissi, Gilbert, Pradel, Gael, Barbar, Saber, Aubert, Clement, Lloret, Sophie, Elotmani, Loubna, Polge, Anne, Lefrant, Jean-Yves, Roberts, Jason A and Muller, Laurent (2015) Standard dosing of amikacin and gentamicin in critically ill patients results in variable and subtherapeutic concentrations. International Journal of Antimicrobial Agents, 46 1: 21-27. doi:10.1016/j.ijantimicag.2015.02.009


Author Roger, Claire
Nucci, Bastian
Molinari, Nicolas
Bastide, Sophie
Saissi, Gilbert
Pradel, Gael
Barbar, Saber
Aubert, Clement
Lloret, Sophie
Elotmani, Loubna
Polge, Anne
Lefrant, Jean-Yves
Roberts, Jason A
Muller, Laurent
Title Standard dosing of amikacin and gentamicin in critically ill patients results in variable and subtherapeutic concentrations
Journal name International Journal of Antimicrobial Agents   Check publisher's open access policy
ISSN 1872-7913
0924-8579
Publication date 2015-07-01
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.ijantimicag.2015.02.009
Open Access Status Not yet assessed
Volume 46
Issue 1
Start page 21
End page 27
Total pages 7
Place of publication Amsterdam, Netherlands
Publisher Elsevier BV
Language eng
Subject 2726 Microbiology (medical)
2725 Infectious Diseases
2736 Pharmacology (medical)
Abstract Low peak plasma concentrations (C-max) of amikacin and gentamicin are reported in intensive care unit( ICU) patients after administration of the first dose. The present study aimed to describe the proportion of ICU patients in whom an adequate C-max was achieved throughout the course of therapy. Septic ICU patients with an indication for intravenous amikacin or gentamicin were eligible for inclusion in this single-centre observational study. The first and subsequent doses and the corresponding C-max values were recorded. The target C-max was >= 60 mg/L for amikacin and >= 30 mg/L for gentamicin. Amikacin and gentamicin plasma concentrations were available in 66 and 24 patients, respectively (59 +/- 17 years; 79 +/- 19 kg; height 169 +/- 12 cm; SAPS II score 46 +/- 19). Pulmonary, abdominal and urinary tract infections were diagnosed in 64 patients. Culture-positive infection was confirmed in 65 patients (72%). A target first C-max was achieved in 17/90 patients (19%). For amikacin, the target C-max was achieved in 16/66 patients (24%) after the initial dose. In the 50 remaining patients, a change in dosing was performed in 14 patients, leading adequate peak plasma level in 2 patients. For gentamicin, the targeted C-max was achieved in only 1/24 patient (4%) after the initial dose and was never achieved after the third dose. In conclusion, standard dosing of amikacin or gentamicin led to adequate C-max in only 19% of patients. Subtherapeutic C-max were not significantly corrected after subsequent doses. (C) 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
Formatted abstract
Low peak plasma concentrations (Cmax) of amikacin and gentamicin are reported in intensive care unit (ICU) patients after administration of the first dose. The present study aimed to describe the proportion of ICU patients in whom an adequate Cmax was achieved throughout the course of therapy. Septic ICU patients with an indication for intravenous amikacin or gentamicin were eligible for inclusion in this single-centre observational study. The first and subsequent doses and the corresponding Cmax values were recorded. The target Cmax was ≥60 mg/L for amikacin and ≥30 mg/L for gentamicin. Amikacin and gentamicin plasma concentrations were available in 66 and 24 patients, respectively (59 ± 17 years; 79 ± 19 kg; height 169 ± 12 cm; SAPS II score 46 ± 19). Pulmonary, abdominal and urinary tract infections were diagnosed in 64 patients. Culture-positive infection was confirmed in 65 patients (72%). A target first Cmax was achieved in 17/90 patients (19%). For amikacin, the target Cmax was achieved in 16/66 patients (24%) after the initial dose. In the 50 remaining patients, a change in dosing was performed in 14 patients, leading adequate peak plasma level in 2 patients. For gentamicin, the targeted Cmax was achieved in only 1/24 patient (4%) after the initial dose and was never achieved after the third dose. In conclusion, standard dosing of amikacin or gentamicin led to adequate Cmax in only 19% of patients. Subtherapeutic Cmax were not significantly corrected after subsequent doses.
Keyword Aminoglycoside
ICU
Peak plasma concentration
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID APP1048652
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
School of Pharmacy Publications
 
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