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

Identifieur interne : 002C26 ( PubMed/Corpus ); précédent : 002C25; suivant : 002C27

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

Auteurs : Claire Roger ; Bastian Nucci ; Nicolas Molinari ; Sophie Bastide ; Gilbert Saissi ; Gael Pradel ; Saber Barbar ; Clément Aubert ; Sophie Lloret ; Loubna Elotmani ; Anne Polge ; Jean-Yves Lefrant ; Jason A. Roberts ; Laurent Muller

Source :

RBID : pubmed:25857948

English descriptors

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 ≥60mg/L for amikacin and ≥30mg/L for gentamicin. Amikacin and gentamicin plasma concentrations were available in 66 and 24 patients, respectively (59±17 years; 79±19kg; height 169±12cm; 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.

DOI: 10.1016/j.ijantimicag.2015.02.009
PubMed: 25857948

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pubmed:25857948

Le document en format XML

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<term>Amikacin (pharmacokinetics)</term>
<term>Anti-Bacterial Agents (administration & dosage)</term>
<term>Anti-Bacterial Agents (pharmacokinetics)</term>
<term>Bacterial Infections (drug therapy)</term>
<term>Cohort Studies</term>
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<div type="abstract" xml:lang="en">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 ≥60mg/L for amikacin and ≥30mg/L for gentamicin. Amikacin and gentamicin plasma concentrations were available in 66 and 24 patients, respectively (59±17 years; 79±19kg; height 169±12cm; 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.</div>
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<AbstractText>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 ≥60mg/L for amikacin and ≥30mg/L for gentamicin. Amikacin and gentamicin plasma concentrations were available in 66 and 24 patients, respectively (59±17 years; 79±19kg; height 169±12cm; 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.</AbstractText>
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<Affiliation>Burns, Trauma and Critical Care Research Centre, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Brisbane 4029, QLD, Australia.</Affiliation>
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<DescriptorName UI="D018410" MajorTopicYN="N">Pneumonia, Bacterial</DescriptorName>
<QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName>
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<QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName>
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</MeshHeadingList>
<KeywordList Owner="NOTNLM">
<Keyword MajorTopicYN="N">Aminoglycoside</Keyword>
<Keyword MajorTopicYN="N">ICU</Keyword>
<Keyword MajorTopicYN="N">Peak plasma concentration</Keyword>
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<Month>11</Month>
<Day>27</Day>
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<PubMedPubDate PubStatus="revised">
<Year>2015</Year>
<Month>02</Month>
<Day>07</Day>
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<PubMedPubDate PubStatus="accepted">
<Year>2015</Year>
<Month>02</Month>
<Day>11</Day>
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<Year>2015</Year>
<Month>4</Month>
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