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An evaluation of amikacin nephrotoxicity in the hematology/oncology population

Patrick J Kiel1, Mimi Lo, Deborah Stockwell

  • 1Department of Pharmacy, Rush University Medical Center, Chicago, Illinois, USA. pkiel@clarian.org

American Journal of Therapeutics
|March 22, 2008
PubMed

Insights

Extended-interval amikacin dosing showed similar nephrotoxicity to conventional dosing in cancer patients. Extended-interval dosing may offer better efficacy for gram-negative infections in this population.

Area of Science:

  • Pharmacology
  • Nephrology
  • Oncology

Background:

  • Amikacin, an aminoglycoside, is crucial for treating gram-negative infections in febrile neutropenia.
  • Dosing strategies (extended-interval vs. conventional) are established in general populations but lack evidence in hematology/oncology patients.
  • Nephrotoxicity and efficacy data for amikacin dosing in oncology are limited.

Purpose of the Study:

  • To compare amikacin-associated nephrotoxicity between conventional and extended-interval dosing regimens.
  • To evaluate the efficacy of these dosing strategies in adult hematology/oncology patients.

Main Methods:

  • A prospective, randomized, open-label trial involving 40 adult hematology/oncology patients.
  • Patients received either conventional or extended-interval amikacin dosing.
  • Nephrotoxicity was assessed by serum creatinine increase; efficacy by pathogen eradication and amikacin serum concentrations.

Main Results:

  • Nephrotoxicity rates were similar: 10% in the conventional group and 5% in the extended-interval group (P = 1.00).
  • Six patients (conventional) had positive cultures versus none (extended-interval) (P = 0.002).
  • Efficacy could not be definitively assessed due to study limitations.

Conclusions:

  • Extended-interval amikacin dosing demonstrates comparable nephrotoxicity to conventional dosing in hematology/oncology patients.
  • Extended-interval dosing may be a more effective strategy for treating gram-negative infections in this population.
  • Further research is needed to fully assess efficacy and optimize dosing in cancer patients.

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