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The necessity of increased doses of amikacin in burn patients
Abstract:
Extended periods (6 to 9 hours) of subtherapeutic serum amikacin levels were observed in five burn patients receiving the recommended intravenous dose of 7.5 mg/kg every 12 hours. Kinetic studies revealed an unusually short half-life, especially in younger patients. This more rapid elimination necessitated a shorter dosing interval (every 6 hours), resulting in an increased daily dose (30 mg/kg/day). In this study of 10 patients with normal renal function, an intravenous dosage regimen of 7.5 mg/kg every 6 hours resulted in therapeutic peak concentrations and shortened intervals of subtherapeutic serum concentrations. A transient episode of tinnitus without cochlear damage occurred in one patient after the first dose. Neither ototoxicity nor nephrotoxicity occurred in any of the patients. Because of interpatient variability in amikacin elimination, frequent monitoring of serum levels with necessary dosage changes is imperative to provide optimal serum concentrations. However, it must be emphasized that these increased dosage regimens of amikacin are not suggested for routine use without previously measuring serum levels.
Insights
Burn patients often experience subtherapeutic amikacin levels. Adjusting the intravenous amikacin dose to 7.5 mg/kg every 6 hours improved therapeutic drug concentrations in patients with normal renal function.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Critical Care Medicine
Background:
- Subtherapeutic amikacin serum concentrations are common in burn patients.
- The standard intravenous dose may lead to prolonged periods below therapeutic levels, particularly in younger individuals.
Purpose of the Study:
- To evaluate the efficacy and safety of an adjusted amikacin dosing regimen in burn patients.
- To determine if a more frequent dosing interval can achieve therapeutic amikacin levels.
Main Methods:
- A study involving 10 burn patients with normal renal function.
- Administered intravenous amikacin at 7.5 mg/kg every 6 hours.
- Monitored serum amikacin levels and assessed for ototoxicity and nephrotoxicity.
Main Results:
- The adjusted regimen (7.5 mg/kg every 6 hours) achieved therapeutic peak amikacin concentrations.
- Shortened the duration of subtherapeutic serum levels.
- One patient experienced transient tinnitus; no ototoxicity or nephrotoxicity was observed.
Conclusions:
- An intravenous amikacin dosage of 7.5 mg/kg every 6 hours is effective in achieving therapeutic levels in burn patients with normal renal function.
- Frequent monitoring of serum amikacin levels is crucial due to interpatient variability.
- Increased dosage regimens require careful consideration and should not be used routinely without therapeutic drug monitoring.