Effect of individualized pharmacokinetic dosing on patient outcome. Crit Care Med 1991 Dec;19(12):1480-5
Date
12/01/1991Pubmed ID
1959366DOI
10.1097/00003246-199112000-00007Scopus ID
2-s2.0-0026322390 (requires institutional sign-in at Scopus site) 41 CitationsAbstract
OBJECTIVE: To study the effect of individualized pharmacokinetic dosing of aminoglycosides on patient outcome.
DESIGN: Prospective, randomized study.
SETTING: Tertiary care hospital.
PATIENTS: Ninety-five patients with documented Gram-negative infections received 97 courses of aminoglycoside therapy.
INTERVENTIONS: Patients were randomized between pharmacokinetic dose adjustment and monitoring or traditional physician-directed techniques. Patients were stratified by severity of underlying illness before randomization.
MEASUREMENT AND MAIN RESULTS: Sixty-two courses of treatment were satisfactorily completed. Patients in the severely ill group (eight kinetic, eight traditional) had significantly (p less than .05) better survival (7 kinetic, 3 traditional) when managed with pharmacokinetic consultation. The kinetic arm received greater doses (156 +/- 59 mg/dose; 2.4 +/- 0.6 mg/kg) than the traditional arm (81 +/- 27 mg/dose; 1.5 +/- 0.6 mg/kg) (p less than .001). In addition, the dose per day (mg/kg) was greater in the kinetic arm (4.1 +/- 1.5) than the traditional arm (3.2 +/- 1.3) (p less than .001). The improved survival was achieved by attaining therapeutic peak serum concentrations earlier in the course of the infection and by administering more total aminoglycoside without increasing toxicity.
CONCLUSIONS: We conclude that pharmacokinetic management of aminoglycoside dosing may improve the outcome of severely ill patients.
Author List
Whipple JK, Ausman RK, Franson T, Quebbeman EJMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Aminoglycosides
Anti-Bacterial Agents
Bias
Cause of Death
Drug Monitoring
Gram-Negative Bacterial Infections
Hospitals, Teaching
Humans
Middle Aged
Prospective Studies
Risk Factors
Severity of Illness Index
Survival Rate
Treatment Outcome
Wisconsin