[Serum gentamicin level after intratracheal application in ventilated patients with normal and reduced kidney...

In a prospective study, serial serum determinations of gentamicin were made after its intratracheal application (40 mg/8 h) to 14 patients on ventilators (seven with normal renal function, seven with compensated, preterminal or dialysis-requiring renal failure). The patients with normal renal function had no therapeutic or toxicologically significant gentamicin concentration in their serum: less than 0.1 mg/l, in one case maximally 0.67 mg/l. But in patients with renal failure even the first gentamicin dose increased the serum level up to 1.5 mg/l. After repeated endotracheal application gentamicin accumulation in serum led to maximal values of 6.2 mg/l after the sixth and 7.5 mg/l after the seventh dose. The absorption of the drug from the tracheobronchial system differed between individuals. Thus serum concentrations were reached in patients with renal failure which are systemically effective and potentially toxic.