Claire Roger1, Bastian Nucci2, Benjamin Louart1, Arnaud Friggeri3, Haroun Knani4, Alexandre Evrard5, Jean-Philippe Lavigne6, Bernard Allaouchiche3, Jean-Yves Lefrant7, Jason A Roberts8, Laurent Muller1. 1. Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France EA 2992, Université de Montpellier, Faculté de Médecine Montpellier Nîmes, Chemin du Carreau de Lanes, 30 908 Nîmes cedex 02, France. 2. Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France. 3. Service de Réanimation, Centre Hospitalier Lyon Sud, Pierre Bénite, France. 4. Service de Pharmacie, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France. 5. Laboratoire de Biochimie, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France. 6. Service de Microbiologie, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France INSERM, U1047, Université de Montpellier, Chemin du Carreau de Lanes, 30 908 Nîmes Cedex 02, France. 7. Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France EA 2992, Université de Montpellier, Faculté de Médecine Montpellier Nîmes, Chemin du Carreau de Lanes, 30 908 Nîmes cedex 02, France jean-yves.lefrant@wanadoo.fr. 8. Burns Trauma and Critical Care Research Centre, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Brisbane 4029, Australia.
Abstract
OBJECTIVES: Low first-dose peak serum concentrations of amikacin and gentamicin are commonly reported in ICU patients. The present study aimed to assess whether 30 mg/kg amikacin or 8 mg/kg gentamicin achieved target concentrations in ICU patients with severe sepsis. PATIENTS AND METHODS: Sixty-three ICU patients (Simplified Acute Physiology Score II = 43 ± 16) with severe sepsis and an indication for intravenous amikacin (n = 47) or gentamicin (n = 16) were included. The first (30 mg/kg amikacin; 8 mg/kg gentamicin) and subsequent doses and corresponding peak concentrations (30 min after the completion of an infusion) were recorded. French guideline target concentrations were ≥60 and ≥30 mg/L for amikacin and gentamicin, respectively. A target pharmacokinetic/pharmacodynamic ratio of 10 × MIC was also measured. RESULTS: Pulmonary, abdominal and urinary tract infections were diagnosed in 56 patients. Infection was confirmed in 37 patients (59%). The targeted first-dose peak concentration was achieved in 37/63 patients (59%) [amikacin 36/47 (77%) and gentamicin 1/16 (6%)], and 59/63 patients (94%) achieved the pharmacokinetic/pharmacodynamic ratio using the MIC data that were available from 21 patients. However, the second dose of aminoglycoside was withheld because of high trough concentrations in nearly half of patients who did not have renal dysfunction. CONCLUSIONS: In this study, 30 mg/kg amikacin and 8 mg/kg gentamicin led to target peak serum concentrations in 59% of patients.
OBJECTIVES: Low first-dose peak serum concentrations of amikacin and gentamicin are commonly reported in ICU patients. The present study aimed to assess whether 30 mg/kg amikacin or 8 mg/kg gentamicin achieved target concentrations in ICU patients with severe sepsis. PATIENTS AND METHODS: Sixty-three ICU patients (Simplified Acute Physiology Score II = 43 ± 16) with severe sepsis and an indication for intravenous amikacin (n = 47) or gentamicin (n = 16) were included. The first (30 mg/kg amikacin; 8 mg/kg gentamicin) and subsequent doses and corresponding peak concentrations (30 min after the completion of an infusion) were recorded. French guideline target concentrations were ≥60 and ≥30 mg/L for amikacin and gentamicin, respectively. A target pharmacokinetic/pharmacodynamic ratio of 10 × MIC was also measured. RESULTS: Pulmonary, abdominal and urinary tract infections were diagnosed in 56 patients. Infection was confirmed in 37 patients (59%). The targeted first-dose peak concentration was achieved in 37/63 patients (59%) [amikacin 36/47 (77%) and gentamicin 1/16 (6%)], and 59/63 patients (94%) achieved the pharmacokinetic/pharmacodynamic ratio using the MIC data that were available from 21 patients. However, the second dose of aminoglycoside was withheld because of high trough concentrations in nearly half of patients who did not have renal dysfunction. CONCLUSIONS: In this study, 30 mg/kg amikacin and 8 mg/kg gentamicin led to target peak serum concentrations in 59% of patients.
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