Comment utiliser les aminosides en réanimation View Full Text


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Article Info

DATE

2015-04-10

AUTHORS

A. Boyer, B. Clouzeau, F. M’zali, M. Kann, D. Gruson-Vescovali

ABSTRACT

The aminoglycosides (AG) schedule of administration in patients with septic shock consists in a high dose once daily (7–9 mg/kg of gentamicin/tobramycin; 25–30 mg/kg of amikacine) in a 30 minutes infusion and for a maximum of 5 days. The total body weight must be used except for obese patients. AG administration in critically ill septic patients is complicated by an extreme inter- and intraindividual variability in drug pharmacokinetic characteristics: the volume of distribution is frequently increased, while the elimination constant can be either increased or decreased. The case for patients needing continuous or discontinuous renal replacement therapy is addressed in this review. The Cmax objective is 8–10 fold the MIC then taper the dose as soon as the MIC has been provided, which unfortunately often takes longer than the AG-treatment duration. Several therapeutic drug monitoring (TDM) options have been proposed in critically ill patients: simple linear dose adjustment according to AG serum concentration to nomograms, other pharmacological method based on the determination of intermediate AG assay before Cmin, and Bayesian methods. The translation of these complex TDM methods into better clinical outcomes remains uncertain but these programs could reduce AG-associated NT in patients with septic shock. Therefore, the questions of the possible application of TDM to ICU setting remain unanswered. Indeed, high workload, often in situation of emergency, is a substantial obstacle to a sophisticated optimized AG administration. A simple linear adjustment of AG doses is recommended so far. All these recommendations have led to a global decrease of AG nephrotoxicity for the last decades. More... »

PAGES

328-336

References to SciGraph publications

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  • 2013-03-19. Aminoglycosides in Septic Shock in DRUG SAFETY
  • 2013-07-25. Therapeutic drug monitoring of amikacin in septic patients in CRITICAL CARE
  • 1996-05. Fluctuation of the volume of distribution of amikacin and its effect on once-daily dosage and clearance in a seriously ill patient in INTENSIVE CARE MEDICINE
  • 2001-11. Individualising Aminoglycoside Dosage Regimens after Therapeutic Drug Monitoring in CLINICAL PHARMACOKINETICS
  • 2002-05-30. Experience with a once-daily dosing program of aminoglycosides in critically ill patients in INTENSIVE CARE MEDICINE
  • 1989-06. A prospective randomised trial comparing individualised pharmacokinetic dosage prediction for aminoglycosides with prediction based on estimated creatinine clearance in critically ill patients in INTENSIVE CARE MEDICINE
  • 1976-04. Pharmacokinetics of dosing regimens which utilize multiple intravenous infusions: Gentamicin in burn patients in JOURNAL OF PHARMACOKINETICS AND PHARMACODYNAMICS
  • 2014-07-04. What is new in the use of aminoglycosides in critically ill patients? in INTENSIVE CARE MEDICINE
  • 1997-03. Drug Administration in Patients with Renal Insufficiency in DRUG SAFETY
  • 1998-10. Economic Impact of Aminoglycoside Toxicity and its Prevention Through Therapeutic Drug Monitoring in PHARMACOECONOMICS
  • 2010-04-06. Revisiting the loading dose of amikacin for patients with severe sepsis and septic shock in CRITICAL CARE
  • 2012-07-09. WAAR (World Alliance against Antibiotic Resistance): Safeguarding antibiotics in ANTIMICROBIAL RESISTANCE & INFECTION CONTROL
  • 2014-04-01. Predictors of insufficient amikacin peak concentration in critically ill patients receiving a 25 mg/kg total body weight regimen in INTENSIVE CARE MEDICINE
  • 2008-10. Drug-Related Nephrotoxic and Ototoxic Reactions in DRUG SAFETY
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