Is gentamicin administered to individual patients in optimal doses already at the beginning of therapy?

M. Göböová 1 , I. Vaňo 1 , V. Kissová 1 , T. Fazekaš 2 , and M. Kuželová 3
  • 1 Department of Internal Medicine, Teaching Hospital Nitra, Nitra
  • 2 Department of Physical Chemistry of Drugs, Faculty of Pharmacy, Comenius University, Bratislava
  • 3 Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava

Abstract

Introduction A gentamicin dose, which the physicians select, frequently does not take any pharmacokinetic parameters into consideration.

Aim To analyse the results of therapeutic drug monitoring (TDM) of gentamicin for those patients who have not had the gentamicin dose adjusted at the beginning of therapy (first group) and for those patients who had the gentamicin dose adjusted at the beginning of therapy (second group).

Methods We acquired the basic data about patients from the requests for laboratory examination of levels of gentamicin. We measured all the gentamicin concentrations mentioned in this work using the FPIA method.

Results The monitored set included 379 hospitalized patients during a 4-year period. We divided the monitored set into 2 groups. First group was composed of patients without dose adjustment of gentamicin at the beginning of therapy, and the second group was composed of patients with dose adjustment of gentamicin by the clinical pharmacist at the beginning of therapy. In addition, the patients in each group were divided according to the body mass index (BMI). In the first group of patients, a low percentage of patients had both optimal levels (trough, peak levels). As for patients with BMI > 25 m2/kg, there were only 17 % such cases, and the patients with BMI ≤ 25 m2/kg were only 18.8 %. In the second group, the patients had all trough and peak levels in optimal therapeutic range at obese patients, overweight patients and also at patients with normal weight (p < 0.001).

Conclusion Adjustment of dosage regimens immediately at the beginning of therapy will provide for administering sufficient doses of antibiotics at the beginning of therapy, which is a pre-condition for a successful anti-infective therapy. Therapeutic monitoring of levels allows for administration of sufficient dose of gentamicin without fear of any undesirable effects.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • [1] Martin J, Barras M, Ah Yui N, Kirkpatrick C, Kubler P, No R: Gentamicin monitoring practices in teaching hospitals – time to undertake the necessary randomised controlled trial. J Clinic Toxicol. 2012;2(8):1–5.

  • [2] Durante-Mangoni E, Grammaticos A, Utili R, Falagas ME: Do we still need the aminoglycosides? Int J Antimicrob Agents. 2009;33(3):201–205.

  • [3] Gómolka M, Niemczyk S: How to safely and effectively administer aminoglycoside antibiotics. Pol. Merkur. Lekarski. 2014;36(214):225–228.

  • [4] Solomkin JS, Mazuski JE, Bradley JS et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect. 2010;11:79–109.

  • [5] Thomson AH, Duncan N, Silverstein B, Alcock S, Jodrell D: Development of gudelines for gentamicin dosing. J Antimicrob Chemother. 1996;38(5):885–893.

  • [6] Cox ZL, Nelsen CL, Waitman LR, McCoy JA, Peterson JF: Clinical Decision Support Improves Initial Dosing and Monitoring of Tobramycin and Amikacin. American Society of Health-System Pharmacist. 2011;68(7): 624–632.

  • [7] Fonzo-Christie C, Guignard B, Zaugg C et al.: Impact of clinical Decision Support Guidelines on Therapeutic Drug Monitoring of Gentamicin in Newborns. Ther Drug Monit. 2014;36(5):656–662.

  • [8] Barza M, Ioannidis JP, Cappelleri JC, Lau J et al.: Single and multiple daily doses of aminoglycosides a meta-analysis. BMJ. 1996;10(312):338–345.

  • [9] Nezic L, Derungs A, Bruggisser M, Tschudin-Sutter S, Krähenbühl S, Haschke M: Therapeutic drug monitoring of once daily aminoglycoside dosing: comparison of two methods and investigation of the optimal blood sampling strategy. Eur J Clin Pharmacol. 2014;70(7):829–837.

  • [10] Radigan EA, Gilchrist NA, Miller MA: Managment of aminoglycosides in the intensive care unit. J Intensive Care Med. 2010;26(6):327–342.

  • [11] Wong G, Sime FB, Lipman, J, Roberts JA: How do we use therapeutic drug monitoring to improve outcome from severe infections in critically ill patients? BMC Infect Dis. 2014;14:288.

OPEN ACCESS

Journal + Issues

Search