Optimizing use of aminoglycosides in the critically ill
1Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA. rhonda_rea@yahoo.com
Seminars in Respiratory and Critical Care Medicine
|December 21, 2007
Summary
Aminoglycosides (AGs) are crucial for treating gram-negative infections. Extended-interval dosing optimizes AG therapy in critically ill patients by achieving target concentrations and reducing toxicity.
Area of Science:
- Pharmacology
- Infectious Diseases
- Critical Care Medicine
Background:
- Increasing bacterial resistance necessitates novel therapeutic strategies.
- Aminoglycosides (AGs) are vital for treating severe gram-negative infections, often used in combination therapy.
- AGs exhibit concentration-dependent killing, making optimized dosing critical.
Purpose of the Study:
- To evaluate the efficacy and safety of extended-interval aminoglycoside dosing in critically ill patients.
- To determine if extended-interval dosing achieves therapeutic targets in the ICU population.
- To compare extended-interval dosing with traditional multiple daily dosing in intensive care unit (ICU) patients.
Main Methods:
- Pharmacokinetic and pharmacodynamic analysis of aminoglycoside dosing regimens.
- Monitoring of peak (Cmax) and trough drug concentrations.
- Determination of pathogen's minimal inhibitory concentration (MIC).
Main Results:
- Extended-interval AG dosing can achieve the target Cmax:MIC ratio (> or = 10) in critically ill patients.
- This optimized dosing is associated with faster infection resolution.
- Critically ill patients exhibit unique pharmacokinetic profiles (e.g., increased volume of distribution, variable clearance) impacting AG dosing.
Conclusions:
- Extended-interval aminoglycoside dosing is a viable strategy for treating serious infections in the ICU.
- Therapeutic drug monitoring, including Cmax and MIC determination, is essential for optimizing AG therapy in critically ill patients.
- This approach may improve patient outcomes while minimizing the risk of nephrotoxicity.
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