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Amikacin therapy for severe gram-negative sepsis: efficacy in infections involving gentamicin-resistant organisms
Abstract:
Thirty-eight patients with 41 serious infections due to gram-negative bacteria were treated with amikacin. Twenty of these infections involved organisms that were resistant to gentamicin. The results of therapy in 31 of the infections satisfied the criteria for bacteriologic and clinical cure. Eight patients with urinary tract infections and obstructive uropathy had a good clinical response, but routine follow-up cultures of urine at 30 days were positive. Two patients had persistent sepsis and were considered therapeutic failures. Toxicity to the eighth nerve was documented in three of 31 patients for whom routine audiometric testing was performed. These results indicate that amikacin is effective in the treatment of serious infections due to gram-negative bacilli and is particularly useful in infections involving resistant organisms.
Insights
Amikacin effectively treats serious gram-negative bacterial infections, including those resistant to gentamicin. While generally successful, careful monitoring for potential eighth nerve toxicity is recommended.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Serious infections caused by gram-negative bacteria pose significant treatment challenges.
- Emerging antibiotic resistance, particularly to gentamicin, necessitates alternative therapeutic options.
Purpose of the Study:
- To evaluate the efficacy and safety of amikacin in treating serious gram-negative bacterial infections.
- To assess amikacin's utility in cases where organisms exhibit resistance to gentamicin.
Main Methods:
- A cohort of 38 patients with 41 serious gram-negative infections received amikacin treatment.
- Infections were assessed for bacteriologic and clinical cure criteria.
- Audiometric testing was performed on a subset of patients to monitor for ototoxicity.
Main Results:
- Amikacin achieved bacteriologic and clinical cure in 31 of 41 infections.
- A good clinical response was observed in 8 patients with urinary tract infections and obstructive uropathy, despite positive follow-up cultures.
- Therapeutic failure occurred in 2 patients with persistent sepsis.
- Ototoxicity (eighth nerve toxicity) was documented in 3 of 31 patients who underwent audiometric testing.
Conclusions:
- Amikacin demonstrates significant efficacy in treating serious infections caused by gram-negative bacilli.
- The drug is particularly valuable for infections involving gram-negative organisms resistant to gentamicin.
- While generally safe, potential eighth nerve toxicity warrants consideration and monitoring.