Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department.

Autor: Cobussen M; Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, the Netherlands., Stassen PM; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands., Posthouwer D; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands., van Tiel FH; Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, the Netherlands., Savelkoul PHM; Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, the Netherlands., Havenith T; Department of Clinical Pharmacy, Maastricht University Medical Centre, Maastricht, the Netherlands., Haeseker MB; Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2019 Jan 22; Vol. 14 (1), pp. e0210012. Date of Electronic Publication: 2019 Jan 22 (Print Publication: 2019).
DOI: 10.1371/journal.pone.0210012
Abstrakt: Objective: To achieve an optimal effect in patients with sepsis at the emergency department (ED), the gentamicin peak-concentration should be sufficiently high (i.e. peak-concentration/MIC ≥8-10). ICU patients with sepsis often need higher gentamicin doses to achieve sufficiently high peak-concentrations. The aim of this study is to investigate which dose is needed to reach adequate peak-concentrations in patients presenting with sepsis at the ED.
Methods: Patients with sepsis at the ED were included from August 2015 until February 2017. Peak-concentrations were measured in blood 30 minutes after the first gentamicin dose. The study consisted of three phases. In the first phase, peak-concentrations were measured after a standard dose of 5mg/kg. In the second phase, a simulation ((peak-concentration/actual dose) × simulated dose) was performed to determine which dose was needed to reach adequate gentamicin peak-concentrations of ≥16mg/L. In the third phase, peak-concentrations were measured for the best simulated dose.
Results: In phase one, of 86 patients who received a dose of 5mg/kg, 34 (39.5%) patients did not reach the target peak-concentration of ≥16mg/L, and 73 (84.9%) did not reach ≥20mg/L. In phase two, the simulation showed that with a dose of 7mg/kg 83 (96.5%) patients would reach peak-concentrations ≥16mg/L, and 67 (77.9%) of ≥20mg/L. In phase three, 53 patients received a dose of 7mg/kg, of whom 45 (84.9%) reached peak-concentrations of ≥16mg/L, and 31 (58.5%) of ≥20mg/L.
Conclusion: Patients with sepsis at the ED need higher doses of gentamicin. A dose of 7mg/kg is needed to achieve adequate peak-concentrations in the majority of patients.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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