Aminoglycoside dosing in burn patients using first-dose pharmacokinetics

Burn patients have altered aminoglycoside pharmacokinetics, which often result in subtherapeutic serum concentrations when these drugs are administered by conventional dosing (CD) methods. First-dose (FD) pharmacokinetic calculations can be used in these patients to determine an appropriate dosing regimen. We reviewed our experience with FD methods (12 patients) and CD methods (14 patients). Therapeutic levels were achieved more promptly in the FD group than in the CD group (44.4 +/- 8.1 vs. 97.1 +/- 12.5 hours; p < 0.005). Therapeutic serum concentrations were achieved with the first set of steady-state levels in 11% of CD patients and in 67% of FD patients (p < 0.005). The FD group required significantly fewer dosing changes (2.1 +/- 0.3) than did the CD group (3.7 +/- 0.7, p < 0.005). These data demonstrate that aminoglycoside dosing using first-dose pharmacokinetics results in improved maintenance of therapeutic serum concentrations compared with conventional methods in burn patients.