Aminoglycoside dosing in burn patients using first-dose pharmacokinetics

Area of Science:

• Pharmacology and Therapeutics
• Burn Medicine
• Clinical Pharmacy

Background:

• Burn patients exhibit altered aminoglycoside pharmacokinetics, frequently leading to subtherapeutic serum concentrations with conventional dosing (CD).
• Aminoglycosides are critical antibiotics for treating infections in burn patients, necessitating optimized dosing strategies.

Purpose of the Study:

• To evaluate the efficacy of first-dose (FD) pharmacokinetic calculations versus conventional dosing (CD) for aminoglycoside therapy in burn patients.
• To determine if FD methods improve the achievement and maintenance of therapeutic aminoglycoside serum concentrations.

Main Methods:

• Retrospective review of burn patients receiving aminoglycosides, comparing outcomes between FD (n=12) and CD (n=14) dosing regimens.
• Analysis of time to achieve therapeutic levels, proportion of patients reaching therapeutic concentrations with initial steady-state levels, and number of dosing adjustments.

Main Results:

• Therapeutic aminoglycoside levels were achieved significantly faster with FD (44.4 ± 8.1 hours) compared to CD (97.1 ± 12.5 hours; p < 0.005).
• Initial steady-state levels achieved therapeutic concentrations in 67% of FD patients versus 11% of CD patients (p < 0.005).
• The FD group required fewer dosing changes (2.1 ± 0.3) than the CD group (3.7 ± 0.7; p < 0.005).

Conclusions:

• First-dose pharmacokinetic dosing significantly improves the promptness and maintenance of therapeutic aminoglycoside serum concentrations in burn patients.
• FD dosing is a superior strategy compared to conventional dosing for optimizing aminoglycoside therapy in this vulnerable patient population.