Critically-ill patients receiving total parenteral nutrition show altered amikacin pharmacokinetics

Population pharmacokinetics of single-dose amikacin in critically ill patients with suspected ventilator-associated pneumonia

“…These values were in accordance with published data on ICU patients. This confirms the issues observed in antimicrobial pharmacokinetic parameters in critically-ill patients [26,27], i.e.adecreaseof drug clearance and an increaseof volume of distribution [28][29][30][31][32]. Significant covariates were 4-hour creatinine clearance for amikacin clearance, and total body weight and PaO 2 /FIO 2 ratio for central volume.…”

Netilmicin in the neonate: pharmacokinetic analysis and influence of parenteral nutrition

“…The discrepancies between the results obtained previously in adult patients with those found in our neonates could be explained by the malnourished status of the adult patients studied and parenteral refeeding 'per se' [2].…”

“…If, like adult patients, neonates receiving PN (compared to intravenous fluids), showed expanded aminoglycoside Vd ([25% increase) [1,2] and reduced peak serum concentrations, therapeutic effectiveness could be potentially compromised. This is clinically important in neonates with sepsis, as rapid attainment of adequate peak serum concentrations in these patients is correlated with improved outcome and patient survival [3].…”

“…Total parenteral nutrition (TPN) [1,2] has been found to increase aminoglycoside volumes of distribution (Vd) and decrease peak concentrations in critically ill adult patients compared to those receiving fluid therapy (FT), possibly through expansion of the extracellular compartment from the large hypertonic osmotic load administered during PN and secondary increases in aminoglycoside clearance. Consequently, higher than usual doses have been recommended for critically ill adult patients in order to attain therapeutic serum concentrations and avoid treatment failures.…”

Evaluation of Current Amikacin Dosing Recommendations and Development of an Interactive Nomogram: The Role of Albumin

“…Vasoactive drugs are commonly required to improve hemodynamic function in patients with sepsis or septic shock and can modify the extracellular fluid compartment and volume of distribution of water soluble antibiotics such as aminoglycosides [60]. In addition, total parenteral nutrition has been correlated with an expanded V and lower Cmax of amikacin as well as with an increase in creatinine clearance [61]. Apart from vancomycin, the effects of other drugs co-administered and parenteral nutrition were not taken into account in the present research.…”