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Aminoglycosides' dosage in hematological malignancies and febrile neutropenia: extended interval or conventional

Cabrera Figueroa Se1,2, Vásquez Remolcoy Da1,2, Cisterna Castillo Pa3

  • 1Personalized Therapy Unit, Regional Clinical Dr Guillermo Grant Benavente Hospital, San Martín, 1436, Concepción, Chile.

Personalized Medicine
|November 1, 2022
PubMed

Insights

Shortening aminoglycoside dosing intervals may improve treatment outcomes for immunocompromised patients with infections. This strategy was effective in a patient with acute myeloid leukemia and extensively drug-resistant bacteria, avoiding toxicity.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Hematology

Background:

  • Febrile neutropenia is a common complication in acute myeloid leukemia patients.
  • Extensively drug-resistant bacteria pose a significant treatment challenge, especially in immunocompromised individuals.
  • Standard aminoglycoside dosing may be less effective in immunocompromised patients due to a reduced postantibiotic effect.

Purpose of the Study:

  • To evaluate the efficacy and safety of a modified aminoglycoside dosing strategy in an immunocompromised patient.
  • To investigate the impact of narrowed aminoglycoside dosage intervals on treatment outcomes in a patient with extensively drug-resistant bacteremia.

Main Methods:

  • A case report of a patient with acute myeloid leukemia and febrile neutropenia.
  • Pharmacokinetic analysis of amikacin plasma concentrations.
  • Dosage interval adjustment of amikacin from extended to 12 and 8-hour intervals.
  • Monitoring of clinical response, procalcitonin levels, and signs of toxicity.

Main Results:

  • The patient achieved a positive clinical response with normalization of body temperature and decreased procalcitonin levels.
  • Successful eradication of extensively drug-resistant Klebsiella pneumoniae bacteremia.
  • No evidence of nephrotoxicity or ototoxicity was observed during treatment.

Conclusions:

  • Narrowing the dosage interval of aminoglycosides may be an effective strategy for treating infections in immunocompromised patients.
  • This modified dosing approach can enhance the postantibiotic effect, leading to improved treatment outcomes.
  • Further studies are warranted to validate this dosing strategy in larger immunocompromised patient populations.
Keywords:
amikacinaminoglycosidesfebrile neutropeniaimmunocompromised patientsoncohematologypersonalized medicinepharmacokinetic/pharmacodynamicpharmacokineticspostantibiotic effecttherapeutic drug monitoring

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