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[Amikacin and gentamicin: a controlled comparison (author's transl)]
Abstract:
In a randomised double-blind study 25 patients each were treated with amikacin (375 mg/d three times i.m.) or gentamicin (three times 80 mg/d i.m.). The dose was decreased according to a predetermined schedule if there was impaired renal function. Treatment indication was urinary tract infections of different severity with gram-negative organisms resistant to penicillin and cephalosporin. The bacteriological findings of a urine sample obtained by bladder puncture three and ten days after the end of treatment were the criterion of success. In addition, the number of white cells in the urine was taken into account. On the basis of various criteria, amikacin was found to give the higher success rate. The most important criterion, disappearance of the initially demonstrated microorganism, demonstrated a statistically significant advantage of amikacin over gentamicin.
Insights
Amikacin demonstrated a higher success rate than gentamicin in treating gram-negative urinary tract infections. This antibiotic showed a statistically significant advantage in eradicating bacteria.
Area of Science:
- Pharmacology
- Infectious Diseases
- Nephrology
Background:
- Gram-negative bacteria are common causes of urinary tract infections (UTIs).
- Antibiotic resistance to penicillin and cephalosporin necessitates alternative treatments.
- Aminoglycosides like amikacin and gentamicin are used for severe UTIs.
Purpose of the Study:
- To compare the efficacy of amikacin versus gentamicin in treating UTIs.
- To evaluate the impact of renal function on aminoglycoside dosing.
- To assess bacteriological eradication and clinical outcomes.
Main Methods:
- A randomized, double-blind study involving 50 patients (25 per group).
- Patients received amikacin (375 mg/d) or gentamicin (240 mg/d) intramuscularly.
- Dosing was adjusted for impaired renal function.
- Treatment success was based on urine culture results (bacteriological eradication) and white blood cell counts at 3 and 10 days post-treatment.
Main Results:
- Amikacin showed a higher overall success rate compared to gentamicin across various criteria.
- Bacteriological eradication, the primary endpoint, was statistically significantly higher with amikacin.
- Both antibiotics were dosed according to renal function.
Conclusions:
- Amikacin is a more effective treatment option than gentamicin for UTIs caused by gram-negative organisms resistant to other antibiotics.
- The study highlights the importance of appropriate dosing based on renal function for aminoglycosides.
- Amikacin offers a statistically significant advantage in achieving bacterial eradication in UTIs.