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Related Experiment Videos

Initial aminoglycoside levels in the critically ill.

W R Summer, J R Michael, J J Lipsky

    Critical Care Medicine
    |December 1, 1983
    PubMed
    Summary
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    Critically ill patients often have low serum aminoglycoside levels, even with standard dosing. This suggests current tobramycin dosage schedules may underestimate the volume of distribution in sepsis patients.

    Area of Science:

    • Pharmacokinetics and Pharmacodynamics
    • Critical Care Medicine
    • Infectious Diseases

    Background:

    • Aminoglycosides are crucial antibiotics for treating severe infections.
    • Accurate dosing is vital to achieve therapeutic efficacy and minimize toxicity.
    • Critically ill patients exhibit altered pharmacokinetics, complicating drug dosing.

    Purpose of the Study:

    • To evaluate initial serum aminoglycoside levels in critically ill patients with presumed sepsis.
    • To assess the correlation between tobramycin dose and serum concentration.
    • To identify potential reasons for suboptimal aminoglycoside levels in this population.

    Main Methods:

    • Twenty-six medical ICU patients with presumed sepsis or septic shock were studied.
    • Serum tobramycin levels were measured 1 hour post-infusion (2 mg/kg over 20 min).

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  • Correlation between administered dose and measured level was analyzed.

    • Main Results:

    • A poor correlation was observed between tobramycin dose and serum levels.
    • 59% of patients had levels below the recommended peak of 5 µg/mL.
    • Low levels suggest an underestimation of the volume of distribution.

    Conclusions:

    • Current tobramycin dosing may be inadequate for critically ill sepsis patients.
    • Altered volume of distribution in critical illness likely contributes to low levels.
    • Dosage adjustments may be necessary to achieve therapeutic aminoglycoside concentrations.