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Use of aminoglycosides in surgical infections
Abstract:
Most infections on the surgical ward are due to one or more gram-negative rods, acting either as the sole pathogens or as principal components in a polymicrobial flora. To date, parenteral aminoglycosides have proven to be the most effective antibiotics for control or treatment of such sepsis. Unfortunately, however, serious complications as well as therapeutic failures do occur. During a 40-month period, 405 surgical patients receiving aminoglycosides (Gentamicin, Tobramycin, Sisomicin, or Amikacin) were prospectively studied with respect to: indications for antibiotic; patient population; serum concentrations of antibiotic according to route of administration, dose in mg/kg/day, and renal function; rapidity of antibiotic excretion in the urine; causative bacteria and their sensitivities to each aminoglycoside as determined by both disc and tube dilution methods; severity and frequency of drug complications; and clinical efficacy of each study antibiotic. Results supported the contention of a superior effectiveness from aminoglycosides for established abdominal and unspecified surgical infections, more rapid development of therapeutic blood levels by intravenous administration, need to alter drug dose according to frequent serum creatinine determinations, increased drug toxicity in dehydrated and shocked patients, preventability of complicating Candida sepsis, and the importance of early as well as adequate surgical debridement and drainage.
Insights
Parenteral aminoglycosides are effective for surgical infections caused by gram-negative rods. Careful monitoring of drug levels and patient hydration is crucial to minimize complications and ensure therapeutic success.
Area of Science:
- Infectious Diseases
- Pharmacology
- Surgical Infections
Background:
- Surgical ward infections frequently involve gram-negative rods.
- Parenteral aminoglycosides are primary treatments for sepsis.
- Aminoglycoside therapy can lead to complications and treatment failures.
Purpose of the Study:
- To prospectively evaluate aminoglycoside use in 405 surgical patients over 40 months.
- To assess indications, patient populations, and drug pharmacokinetics.
- To determine causative bacteria, sensitivities, complications, and clinical efficacy.
Main Methods:
- Prospective study of 405 surgical patients receiving aminoglycosides (Gentamicin, Tobramycin, Sisomicin, Amikacin).
- Analysis of antibiotic indications, patient demographics, and serum concentrations.
- Evaluation of urinary excretion, bacterial sensitivities (disc and tube dilution), drug toxicity, and clinical outcomes.
Main Results:
- Aminoglycosides demonstrated superior effectiveness for abdominal and unspecified surgical infections.
- Intravenous administration led to more rapid therapeutic blood levels.
- Altering drug dosage based on serum creatinine and recognizing increased toxicity in dehydrated/shocked patients were critical.
- Candida sepsis was preventable, and early surgical intervention was vital.
Conclusions:
- Aminoglycosides are effective for gram-negative bacterial sepsis in surgical patients.
- Therapeutic drug monitoring and dose adjustments based on renal function are essential.
- Optimizing surgical management alongside antibiotic therapy improves patient outcomes.