Aminoglycoside utilization study

A retrospective review of aminoglycoside (AG) use in a tertiary care medical center/teaching hospital was conducted and use patterns were evaluated. Guidelines for AG use were approved by the Pharmacy and Therapeutics Committee and study criteria were developed to assess several parameters involving AG therapy, such as appropriateness of drug use, dosage, duration of therapy, and monitoring for toxicity. The study was conducted as part of a pharmacy quality assurance program in combination with the pharmacokinetic consultation service. A study population of 100 patients receiving an AG (gentamicin: 51, tobramycin: 33, amikacin: 16) was randomly selected from a total population of 250 patients who received AG therapy during August 1985. Medical patients accounted for 65% of AG use while surgical patients accounted for 30%. The majority of patients (84%) received an AG for an appropriate indication. Pretreatment culture/susceptibility and renal function was assessed for 89% and 91% of the patients, respectively. The study revealed problems with loading doses, maintenance doses and serum drug level monitoring. The majority of study patients did not have serum drawn for drug level determination at an appropriate time; therefore, dosage regimen decisions could not be made based on peak and trough values. No clinical nephrotoxicity was detected during treatments. The results of this study indicated the need for educating clinicians with respect to basic and applied AG pharmacokinetic principles and the importance of monitoring patients using the pharmacokinetic consultation service.