High-dose amikacin for achieving serum target levels in critically ill elderly patients

Sadeghi, K. and Hamishehkar, H. and Najmeddin, F. and Ahmadi, A. and Hazrati, E. and Honarmand, H. and Mojtahedzadeh, M. (2018) High-dose amikacin for achieving serum target levels in critically ill elderly patients. Infection and Drug Resistance, 11. pp. 223-228.

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Abstract

Introduction: To achieve target concentrations, the application of higher-than-standard doses of amikacin is proposed for the treatment of sepsis due to an increase in volume of distribution and clearance, but little data are available on aminoglycoside administration in critically ill elderly patients. Patients and methods: Forty critically ill elderly patients (aged over 65 years) who required amikacin therapy due to severe documented, or suspected gram-negative infections, were randomly assigned to two treatment groups. Group A (20 patients) received 15 mg/kg amikacin and Group B (20 patients) received 25 mg/kg amikacin per day as a single daily dose. All the patients were monitored for renal damage by the daily monitoring of serum creatinine. The amikacin peak (Cmax) and trough (Cmin) serum concentrations were measured on Days 3 and 7 postadministration. Results: Data from 18 patients in Group A and 15 patients in Group B were finally analyzed. On Day 3, the amikacin mean Cmax levels in the standard and high-dose treatment groups were 30.4±11 and 52.3±16.1 µg/mL (P<0.001), and the Cmin levels were 3.2±2.1 and 5.2±2.8 µg/mL, respectively (P=0.035). On Day 7, the Cmax levels in the standard and high-dose groups were 33±7.3 and 60.0±17.6 µg/mL (P=0.001), and the Cmin levels were 3.2±2.9 and 9.3±5.6 µg/mL, respectively (P=0.002). In only six (40) of the patients in the high-dose groups and none of the patients in the standard-dose group, amikacin Cmax reached the target levels (>64 µg/mL), whereas the amikacin mean Cmin levels in the high-dose group were above the threshold of toxicity (5 µg/mL). Conclusion: Our results suggest that the optimum dose of amikacin should be determined for elderly critically ill patients. It seems that higher-than-standard doses of amikacin with more extended intervals might be more appropriate than standard once-daily dosing in the elderly critically ill patients. © 2018 Sadeghi et al.

Item Type: Article
Additional Information: Cited By :1 Export Date: 16 February 2020 Correspondence Address: Mojtahedzadeh, M.; Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, 16 Azar Street, Iran; email: mojtahed@sina.tums.ac.ir
Uncontrolled Keywords: Amikacin Critical illness Elderly High-dose Pharmacokinetics Therapeutic drug monitoring Acinetobacter baumannii aged Article blood culture cause of death clinical article controlled study creatinine blood level critically ill patient disease severity drug blood level drug dose comparison drug half life drug megadose Escherichia coli female Gram negative infection human kidney injury Klebsiella male maximum concentration minimum concentration multicenter study nonhuman optimal drug dose patient monitoring Pseudomonas aeruginosa randomized controlled trial single drug dose treatment outcome
Subjects: QV pharmacology
Divisions: Mashhad University of Medical Sciences
Depositing User: lib2 lib2 lib2
Date Deposited: 05 May 2020 03:21
Last Modified: 05 May 2020 03:21
URI: http://eprints.mums.ac.ir/id/eprint/17500

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