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Efficacy of dosage schedule for rational dosage prescribing of gentamicin
V Thamlikitkul1, P Tappayuthpijarn
1Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract:
In our pilot study of 30 patients who were on gentamicin, the adequate peak level (5-10 mg/dl) was found in 27 per cent, trough level (less than 2 mg/dl) in 67 per cent and both peak and trough level in only 10 per cent. We have several reasons to believe that it is due to inappropriate dosage prescribing. The objective of the study is to test the efficacy of using a recommended dosage schedule for rational dosage prescribing of gentamicin. All medical residents were invited to attend a 2-hour session on gentamicin pharmacokinetics. The problems and the use of recommended dosage schedule were extensively discussed. Then serum gentamicin levels were re-monitored by Fluorescence Polarization Immunoassay (TDx). Of 73 gentamicin recipients, 39 (53%, C gr.) were given at the correct dosage according to the schedule and 34 (47%, IC gr) were given incorrectly. The characteristics of the patients in both groups were not different. The appropriate peak, trough, peak and trough levels in C gr were 87, 80, 67 per cent respectively compared with 24, 80 and 9 per cent in the IC group, p less than 10(-4) for peak, peak and trough. The incidence of nephrotoxicity was not different between the two groups. The patients' outcomes were difficult to assess because most of the patients received antibiotic combinations. However, case fatality of documented gram-negative infection tended to be less in the C group. It is concluded that dosage schedule can improve rational dosage prescribing of gentamicin. Most of the patients given gentamicin may not need monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Implementing a gentamicin dosage schedule significantly improved rational prescribing, achieving adequate peak and trough levels in most patients. This suggests routine therapeutic drug monitoring may not be necessary for all gentamicin recipients.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Infectious Diseases
Background:
- Pilot study revealed suboptimal gentamicin peak and trough levels in 90% of patients, likely due to inappropriate prescribing.
- Inadequate gentamicin dosing can lead to treatment failure and increased toxicity risk.
Purpose of the Study:
- To evaluate the effectiveness of a recommended dosage schedule in improving rational gentamicin prescribing.
- To determine if a standardized dosing approach enhances therapeutic drug level achievement.
Main Methods:
- A 2-hour educational session on gentamicin pharmacokinetics and a recommended dosage schedule was provided to medical residents.
- Serum gentamicin levels were re-monitored using Fluorescence Polarization Immunoassay (TDx) after the intervention.
- Patients were divided into a correctly dosed group (C gr) and an incorrectly dosed group (IC gr).
Main Results:
- The correctly dosed group (C gr) showed significantly higher appropriate peak (87% vs 24%) and combined peak/trough levels (67% vs 9%) compared to the incorrectly dosed group (IC gr).
- No significant difference in nephrotoxicity incidence was observed between the groups.
- Case fatality for gram-negative infections trended lower in the correctly dosed group.
Conclusions:
- A gentamicin dosage schedule effectively improves rational prescribing practices.
- Implementing standardized dosing protocols can optimize gentamicin therapy, potentially reducing the need for routine therapeutic drug monitoring.