Therapeutic Drug Monitoring of High-Dose Gentamicin in an Elderly Patient: A Case Report

Al-Lanqawi, Yousef; Capps, Phillip A.; Abdulmalik, Kefaya

doi:10.1159/000086937

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…The rationale of once daily dosing is to achieve a high peak concentration which increases the postantibiotic effect and may also help minimize toxicity [8][9][10] . In Kuwait, gentamicin treatment in hospitalized patients is based on traditional multiple daily dosing (often 80 mg every 8 or 12 h).…”

Section: Objectivesmentioning

confidence: 99%

Clinical Pharmacokinetics of Gentamicin

Al-Lanqawi¹,

Capps²,

Abudlmalek

et al. 2009

Med Princ Pract

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Objectives: The objectives of this study were to: (1) derive equations for estimating gentamicin clearance (Cl_gent) and volume of distribution (V_d) based on the local population attending Al-Amiri Hospital, Kuwait; (2) independently evaluate these equations by comparison with other published methods in their predictive ability to estimate Cl_gent and V_d. Materials and Methods: Cl_gent and V_d were calculated in 47 patients (group 1) using the Sawchuk-Zaske method. Regression analysis was used to derive a correlation between creatinine clearance (Cl_cr) and Cl_gent, V_d and actual body weight (ABW). Based on actual Cl_gent and V_d values, the predictive ability of the estimated parameters from the regression equations was validated and compared with 4 published methods using mean error (ME), i.e. bias, and mean squared error (MSE) and root mean squared error (RMSE), i.e. precision. All equations were also evaluated in an independent second group (group 2) of 23 patients. Results: The mean ± SD values of Cl_gent and V_d were 4.0 ± 1.8 l·h^–1 and 16.8 ± 6.7 liters, respectively. The derived equations were: Cl_gent = (0.760) (Cl_cr) + 1.117 (r = 0.701) and V_d = (0.165) (ABW) + 5.604 (r = 0.532). In comparison to the 4 published methods, the derived equations were less biased (ME = 0.00) and more precise (MSE = 1.68, RMSE = 1.02) in predicting Cl_gent (p < 0.05), and less biased (ME = –0.01) with no difference in precision (MSE = 36.22, RMSE = 4.59) in predicting V_d (p > 0.05). This precision was confirmed in the second group of 23 patients, where the derived equations were less biased (ME = –0.1) and more precise (MSE = 3.22, RMSE = 1.48) in predicting Cl_gent (p < 0.05), whilst no difference was found for prediction of V_d (p > 0.05). Conclusion: The equations developed in this study provided a reliable estimation of Cl_gent and V_d. It is planned to use them at Kuwait Hospitals to help provide more individualized patient dosing information to physicians.

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Section: Objectivesmentioning

confidence: 99%

Clinical Pharmacokinetics of Gentamicin

Al-Lanqawi¹,

Capps²,

Abudlmalek

et al. 2009

Med Princ Pract

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“…Recently, once-daily dosing strategies have been recommended in many clinical settings. The rationale for these strategies is that high peak serum concentrations enhance the concentrationdependent bactericidal activity of gentamicin against gram-negative infections [7,8] and that this drug has a postantibiotic effect that is longer when the peak drug level is higher [9] . Once-daily gentamicin has an equivalent efficacy and a trend towards reduced toxicity compared with traditional dosing methods [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Drug Monitoring of Gentamicin: Evaluation of Five Nomograms for Initial Dosing at Al-Amiri Hospital in Kuwait

Al-Lanqawi

Capps²,

Abdel-Hamid³

et al. 2007

Med Princ Pract

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Objective: To compare five published nomograms (Thomson guidelines, Mawer nomogram, rule of eights, Hull-Sarubbi table and Dettli method) for calculating the initial gentamicin dosage regimen in a Kuwaiti population. Materials and Methods: Based on measured peak and trough gentamicin concentrations, the elimination rate constant and volume of distribution of gentamicin were calculated for each patient (n = 56), using a modified two-point Sawchuk-Zaske method. The calculated individual set of pharmacokinetic parameters and the initial dose regimen recommended by each of the five methods were used to predict the steady-state peak and trough of gentamicin concentrations. Results: The Thomson guidelines produced consistent results in predicting gentamicin concentrations within the target ranges of peak plus trough, peak only and trough only (63, 75 and 75%, respectively). The Mawer nomogram, Hull-Sarubbi table and Dettli methods achieved similar percentages of patients (46–50%) within the target ranges (5–10 mg · l^–1 for peak and 0.5–2 for trough), whereas empirical dosing and the rule of eights showed the lowest percentages of patients within the peak plus trough target range (25 and 37%, respectively). However, with respect to the underdosing target range (predicted concentration <5 mg · l^–1), the Thomson guidelines showed that 21% of patients were underdosed. Conclusion: The results show that a large number of patients (37–63%) were outside the target ranges in all initial gentamicin dosing methods evaluated in this study. Therefore, serum concentration measurement can be advised to assist in the optimization of gentamicin dose selection.

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Therapeutic Drug Monitoring of High-Dose Gentamicin in an Elderly Patient: A Case Report

Cited by 2 publications

References 6 publications

Clinical Pharmacokinetics of Gentamicin

Clinical Pharmacokinetics of Gentamicin

Therapeutic Drug Monitoring of Gentamicin: Evaluation of Five Nomograms for Initial Dosing at Al-Amiri Hospital in Kuwait

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