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Aminoglycoside Pharmacokinetics in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy.
- Source :
- Annals of Pharmacotherapy; Jun2023, Vol. 57 Issue 6, p629-636, 8p
- Publication Year :
- 2023
-
Abstract
- Background: There are few studies describing aminoglycoside pharmacokinetics during continuous renal replacement therapy (CRRT). Objective: To characterize the effect of CRRT on aminoglycoside clearance and volume of distribution (V<subscript>d</subscript>). Methods: Retrospective observational pharmacokinetic study of adult critically ill oncologic patients who received a first dose of amikacin or tobramycin during CRRT between February 2012 and May 2017. Study outcomes included aminoglycoside clearance, V<subscript>d</subscript>, and attainment of the target peak: MIC (minimum inhibitory concentration) ratio as a surrogate for dosing appropriateness. Results: In total, 80 patients were included, sustained low-efficiency dialysis (SLED), n = 49; continuous venovenous hemodialysis (CVVHD), n = 19; continuous venovenous hemofiltration (CVVH), n = 12. Fifty-one patients received amikacin at a median dose of 14.5 mg/kg per actual body weight and achieved a median peak level of 26.7 mg/L. Twenty-nine patients received tobramycin at a median dose of 6.5 mg/kg actual body weight and achieved a median peak level of 10.3 mg/L. The median aminoglycoside clearance was 63.1 mL/min and was similar between CRRT modality groups (P = 0.97). The median V<subscript>d</subscript> was 0.47 L/kg and was different between the SLED and CVVH groups (P = 0.007). Attainment of target peak: MIC occurred in 29% in the total study population and 44% in the subgroup of 23 patients with isolates tested for aminoglycoside susceptibility. Conclusion and Relevance: Critically ill oncology patients undergoing CRRT exhibited reduced clearance and expanded V<subscript>d</subscript> that was not significantly different between CRRT modalities. Current dosing regimens led to low peak concentrations and poor attainment of pharmacokinetic targets. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10600280
- Volume :
- 57
- Issue :
- 6
- Database :
- Complementary Index
- Journal :
- Annals of Pharmacotherapy
- Publication Type :
- Academic Journal
- Accession number :
- 163714444
- Full Text :
- https://doi.org/10.1177/10600280221120600