Effect of Nutritional Status on the Clinical Efficacy of Once-daily Dosing Regimens of Amikacin Sulfate in Elderly Patients

Matsuki, Yoshihiko; Yajima, Miki; Tsukamoto, Tetsuya; Watanabe, Tamaki; Watanabe, Shigekazu

doi:10.4058/jsei.33.7

Cited by 1 publication

(1 citation statement)

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“…Finally, French guidelines recommend that the targeted minimum concentration is below 2.5 mg/L [43]. However, we used the minimum concentration of < 4 mg/L to define amikacin-related renal toxicity based on a previous study reporting that the incidence of renal function impairment was significantly higher in elderly patients with a minimum concentration of amikacin of ≥ 4 mg/L [44].…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics Analysis of Amikacin Initial Dosing Regimen in Elderly Patients

et al. 2021

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There are limited data of amikacin pharmacokinetics (PK) in the elderly population. Hence, we aimed to describe the population PK of amikacin in elderly patients (>70 years old) and to establish optimized initial dosing regimens. We simulated individual maximum concentrations in plasma (Cmax) and minimal concentrations (Cmin) for several dosing regimens (200–2000 mg every 24, 48, and 72 h) for patients with creatinine clearance (CCr) of 10–90 mL/min and analyzed efficacy (Cmax/minimal inhibitory concentration (MIC) ≥ 8) for MICs of 4, 8, and 16 mg/L and safety (Cmin < 4 mg/L). A one-compartment model best described the data. CCr was the only covariate associated with amikacin clearance. The population PK parameter estimates were 2.25 L/h for clearance and 18.0 L for volume of distribution. Dosing simulations recommended the dosing regimens (1800 mg) with dosing intervals ranging 48–72 h for patients with CCr of 40–90 mL/min based on achievement of both efficacy for the MIC of 8 mg/L and safety. None of the dosing regimens achieved the targets for an MIC of 16 mg/L. We recommend the initial dosing regimen using a nomogram based on CCr for an MIC of ≤8 mg/L in elderly patients with CCr of 40–90 mL/min.

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Section: Discussionmentioning

confidence: 99%