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Simplified monitoring of aminoglycoside treatment
1Department of Infectious Diseases, University of Lund, Malmö General Hospital, Sweden.
Abstract:
Aminoglycosides are effective but toxic antibiotics. They are usually administered by repeated daily injections with the dosage adjusted according to twice-weakly monitoring of serum concentrations. A recent study involving 60 patients with severe infections proposed simplified administration and monitoring of aminoglycosides. The patients were randomly treated with either gentamicin or netilmicin given by once daily or thrice daily injections. No difference was found in efficacy or in toxicity between the various groups. In drugs excreted by glomerular filtration, the daily dose should be proportional to renal clearance. This we assessed by aminoglycoside clearance, calculated from trough and peak concentrations of the drug in serum. We also estimated creatinine clearance by a simple equation derived from the knowledge that the urinary excretion of creatinine is proportional to the muscle mass, decreasing with age. For women, creatinine clearance (ml/min) should be [150.age (years)].body weight (kg)/serum creatinine (mumol/l). For men less than 70 years, the figure 150 should be substituted by 170, and at 70 years or older, by 160. We used 51Cr-EDTA clearance as an independent arbiter to decide which mode was best suited for monitoring aminoglycoside therapy. The results showed that estimated creatinine clearance corresponded better to 51Cr-EDTA clearance than did aminoglycoside clearance based on assay of serum concentrations (correlation coefficients for patients with single-dose treatment 0.81 vs. 0.72). In the study we monitored aminoglycoside treatment in the conventional manner according to the patient's weight and adjusted the dose after assay of the drug's serum concentration.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Simplified monitoring of aminoglycoside antibiotics, like gentamicin, is effective for severe infections. Estimated creatinine clearance better predicts drug levels than traditional methods, improving patient care and reducing toxicity risks.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Aminoglycosides are crucial antibiotics but carry significant toxicity risks.
- Current treatment involves frequent injections and serum concentration monitoring, complicating patient management.
- Severe infections necessitate careful aminoglycoside dosing to balance efficacy and safety.
Purpose of the Study:
- To evaluate a simplified administration and monitoring strategy for aminoglycoside antibiotics.
- To compare the accuracy of estimated creatinine clearance versus aminoglycoside clearance in guiding therapy.
- To determine the optimal method for monitoring aminoglycoside treatment in patients with severe infections.
Main Methods:
- A randomized study of 60 patients with severe infections comparing once-daily and thrice-daily aminoglycoside (gentamicin or netilmicin) injections.
- Estimation of creatinine clearance using a validated formula based on age, weight, and serum creatinine.
- Comparison of estimated creatinine clearance and aminoglycoside clearance with 51Cr-EDTA clearance as a gold standard.
Main Results:
- No significant differences in efficacy or toxicity were observed between different dosing frequencies.
- Estimated creatinine clearance showed a stronger correlation with 51Cr-EDTA clearance (r=0.81) compared to aminoglycoside clearance (r=0.72).
- Conventional monitoring based on serum drug concentrations was less accurate than estimated creatinine clearance.
Conclusions:
- Simplified, once-daily aminoglycoside administration is as effective and safe as traditional multi-daily dosing.
- Estimated creatinine clearance is a more reliable method for adjusting aminoglycoside doses than monitoring serum drug concentrations.
- This approach offers a more practical and accurate strategy for managing aminoglycoside therapy in patients with severe infections.