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Low first-dose peak serum concentrations of amikacin and gentamicin are reported in intensive care unit (ICU) patients.1
The present study aimed at assessing the impact of giving high doses of amikacin (30 mg/kg) or gentamicin (8 mg/kg) in ICU patients with severe sepsis.
Single-center observational study. All ICU patients with clinical indication of aminoglycosides were eligible.ICU physicians were encouraged to administer maximal recommended doses of amikacin and gentamicin (30 and 8 mg/kg, respectively). The first and subsequent doses and corresponding peak plasma concentrations were recorded. Guideline targets for serum concentrations were used with ≥60 and ≥30 mg/L for amikacin and gentamicin, respectively. A target pharmacokinetic/pharmacodynamic (PK/PD) ratio of 10-times the minimal inhibitory concentration (10xMIC) was also measured.
Sixty-three ICU patients (39 males, 68 ± 16 years, 75 ± 22 kg, 168 ± 8 cm, SAPS II = 43 ± 16) with severe sepsis and an indication for IV amikacin (n= 47) or gentamicin (n = 16), were included. Pulmonary, abdominal and urinary tract infections were diagnosed in 56 patients. Infection was confirmed in 37 (59%) patients. The target first-dose peak serum concentration was achieved in 37/63 patients (59%)(36/47 (77%) and 1/16 (6%) patient for amikacin and gentamicin, respectively). 59/63 (94%) patients achieved the PK/PD target using the MIC data that was available from 21 patients. However, the subsequent injection should be cancelled in nearly half of patients due to a too high trough, without renal function impairment.
30 mg/kg amikacin and 8 mg/kg gentamicin doses led to adequate peak serum concentrations in 59% patients using guideline targets.