1
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Grit GF, Toren-Wielema ML, Colin PJ, Touw DJ. Gentamicin Administration in Dialysis Patients: Before or After Hemodialysis? Ther Drug Monit 2023; 45:697-701. [PMID: 36730889 DOI: 10.1097/ftd.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gentamicin is used to treat severe infections and has a small therapeutic window. This study aimed to optimize the dosing strategy of gentamicin in intermittently hemodialyzed patients by simulating concentration-time profiles during pre- and postdialysis dosing, based on a published pharmacokinetic model. METHODS Pharmacokinetic simulations were performed with virtual patients, including septic patients, who were treated with gentamicin and received weekly hemodialysis with an interval of 48 h-48 h-72 h. The following dosing regimens were simulated: for nonseptic patients, 5 mg/kg gentamicin was given 1 h or 2 h before dialysis or a starting dose of 2.5 mg/kg and a maintenance dose of 1.5 mg/kg immediately after dialysis were given; for septic patients, 6 mg/kg gentamicin was given 1 h or 2 h before dialysis or a starting dose of 3 mg/kg and a maintenance dose of 1.8 mg/kg immediately were given after dialysis. The mean maximum concentration (C max ), area under the curve (AUC) 24 h , and target attainment (TA) of pharmacodynamic targets were calculated and compared. The following targets were adopted from the literature: C max >8 mg/L and <20 mg/L and AUC 24 h >70 mg·h/L and <120 mg·h/L. RESULTS In nonseptic patients, postdialysis dosing resulted in a TA of 35% for C max of >8 mg/L, 100% for <20 mg/L and AUC 24 h >70 mg·h/L, and 45% for <120 mg·h/L. Dosing 2 h before dialysis resulted in a TA of 100% for C max of >8 mg/L, 40% for <20 mg/L, 65% for AUC 24 h >70 mg·h/L, and 77% for <120 mg·h/L. Simulations of septic patients resulted in comparable outcomes with higher TAs for C max <20 mg/L (96%), AUC 24 h >70 mg·h/L (90%), and AUC 24 h <120 mg·h/L (53%) for dosing 1 h before dialysis. CONCLUSIONS Postdialysis dosing resulted in a low TA of C max >8 mg/L; however, predialysis dosing ensured a high TA of C max >8 mg/L and acceptable TA of C max <20 mg/L, AUC 24 h >70 mg·h/L, and AUC 24 h <120 mg·h/L, which could increase the efficacy of gentamicin. Therefore, clinicians should consider predialysis dosing of gentamicin in patients undergoing intermittent hemodialysis.
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Affiliation(s)
- Geeske F Grit
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; and
| | - Martha L Toren-Wielema
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; and
| | - Pieter J Colin
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; and
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2
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Thy M, Timsit JF, de Montmollin E. Aminoglycosides for the Treatment of Severe Infection Due to Resistant Gram-Negative Pathogens. Antibiotics (Basel) 2023; 12:antibiotics12050860. [PMID: 37237763 DOI: 10.3390/antibiotics12050860] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Aminoglycosides are a family of rapidly bactericidal antibiotics that often remain active against resistant Gram-negative bacterial infections. Over the past decade, their use in critically ill patients has been refined; however, due to their renal and cochleovestibular toxicity, their indications in the treatment of sepsis and septic shock have been gradually reduced. This article reviews the spectrum of activity, mode of action, and methods for optimizing the efficacy of aminoglycosides. We discuss the current indications for aminoglycosides, with an emphasis on multidrug-resistant Gram-negative bacteria, such as extended-spectrum β-lactamase-producing Enterobacterales, carbapenemase-producing Enterobacterales, multidrug-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii. Additionally, we review the evidence for the use of nebulized aminoglycosides.
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Affiliation(s)
- Michaël Thy
- Assistance Publique Hôpitaux de Paris (AP-HP), Service de Médecine Intensive et Réanimation Infectieuse, Hôpital Bichat Claude-Bernard, Université Paris Cité, 46 Rue Henri Huchard, 75018 Paris, France
- Equipe d'accueil (EA) 7323, Department of Pharmacology and Therapeutic Evaluation in Children and Pregnant Women, Université Paris Cité, 75018 Paris, France
| | - Jean-François Timsit
- Assistance Publique Hôpitaux de Paris (AP-HP), Service de Médecine Intensive et Réanimation Infectieuse, Hôpital Bichat Claude-Bernard, Université Paris Cité, 46 Rue Henri Huchard, 75018 Paris, France
- Unité mixte de Recherche (UMR) 1137, Infection, Antimicrobials, Modelization, Epidemiology (IAME), Institut National de la Recherche Médicale (INSERM), Université Paris Cité, 75018 Paris, France
| | - Etienne de Montmollin
- Assistance Publique Hôpitaux de Paris (AP-HP), Service de Médecine Intensive et Réanimation Infectieuse, Hôpital Bichat Claude-Bernard, Université Paris Cité, 46 Rue Henri Huchard, 75018 Paris, France
- Unité mixte de Recherche (UMR) 1137, Infection, Antimicrobials, Modelization, Epidemiology (IAME), Institut National de la Recherche Médicale (INSERM), Université Paris Cité, 75018 Paris, France
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3
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Tessier JF, Ouellet G, Vallée M, Lafrance JP. Experience With Pre-Dialysis Administration of Tobramycin in the Outpatient Setting. Can J Kidney Health Dis 2022; 9:20543581221112505. [PMID: 35860650 PMCID: PMC9290086 DOI: 10.1177/20543581221112505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jean-François Tessier
- Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Georges Ouellet
- Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Michel Vallée
- Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Jean-Philippe Lafrance
- Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.,Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.,Département de pharmacologie et physiologie, Université de Montréal, QC, Canada
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4
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Hodiamont CJ, van den Broek AK, de Vroom SL, Prins JM, Mathôt RAA, van Hest RM. Clinical Pharmacokinetics of Gentamicin in Various Patient Populations and Consequences for Optimal Dosing for Gram-Negative Infections: An Updated Review. Clin Pharmacokinet 2022; 61:1075-1094. [PMID: 35754071 PMCID: PMC9349143 DOI: 10.1007/s40262-022-01143-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/04/2022]
Abstract
Gentamicin is an aminoglycoside antibiotic with a small therapeutic window that is currently used primarily as part of short-term empirical combination therapy. Gentamicin dosing schemes still need refinement, especially for subpopulations where pharmacokinetics can differ from pharmacokinetics in the general adult population: obese patients, critically ill patients, paediatric patients, neonates, elderly patients and patients on dialysis. This review summarizes the clinical pharmacokinetics of gentamicin in these patient populations and the consequences for optimal dosing of gentamicin for infections caused by Gram-negative bacteria, highlighting new insights from the last 10 years. In this period, several new population pharmacokinetic studies have focused on these subpopulations, providing insights into the typical values of the most relevant pharmacokinetic parameters, the variability of these parameters and possible explanations for this variability, although unexplained variability often remains high. Both dosing schemes and pharmacokinetic/pharmacodynamic (PK/PD) targets varied widely between these studies. A gentamicin starting dose of 7 mg/kg based on total body weight (or on adjusted body weight in obese patients) appears to be the optimal strategy for increasing the probability of target attainment (PTA) after the first administration for the most commonly used PK/PD targets in adults and children older than 1 month, including critically ill patients. However, evidence that increasing the PTA results in higher efficacy is lacking; no studies were identified that show a correlation between estimated or predicted PK/PD target attainment and clinical success. Although it is unclear if performing therapeutic drug monitoring (TDM) for optimization of the PTA is of clinical value, it is recommended in patients with highly variable pharmacokinetics, including patients from all subpopulations that are critically ill (such as elderly, children and neonates) and patients on intermittent haemodialysis. In addition, TDM for optimization of the dosing interval, targeting a trough concentration of at least < 2 mg/L but preferably < 0.5–1 mg/L, has proven to reduce nephrotoxicity and is therefore recommended in all patients receiving more than one dose of gentamicin. The usefulness of the daily area under the plasma concentration–time curve for predicting nephrotoxicity should be further investigated. Additionally, more research is needed on the optimal PK/PD targets for efficacy in the clinical situations in which gentamicin is currently used, that is, as monotherapy for urinary tract infections or as part of short-term combination therapy.
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Affiliation(s)
- Caspar J Hodiamont
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Annemieke K van den Broek
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne L de Vroom
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jan M Prins
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Hospital Pharmacy and Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Reinier M van Hest
- Hospital Pharmacy and Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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5
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He S, Cheng Z, Xie F. Population Pharmacokinetics and Dosing Optimization of Gentamicin in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy. Drug Des Devel Ther 2022; 16:13-22. [PMID: 35023902 PMCID: PMC8747548 DOI: 10.2147/dddt.s343385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/23/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Appropriate gentamicin dosing in continuous renal replacement therapy (CRRT) patients remains undefined. This study aimed to develop a population pharmacokinetic (PK) model of gentamicin in CRRT patients and to infer the optimal dosing regimen for gentamicin. Methods Fourteen CRRT patients dosed with gentamicin were included to establish a population PK model to characterize the variabilities and influential covariates of gentamicin. The pharmacokinetic/pharmacodynamic (PK/PD) target attainment and risk of toxicity for different combinations of gentamicin regimens (3–7 mg/kg q24h) and CRRT effluent doses (30–50 mL/h/kg) were evaluated by Monte Carlo simulation. The probability of target attainment (PTA) was determined for the PK/PD indices of the ratio of drug peak concentration/minimum inhibitory concentration (Cmax/MIC > 10) and the ratio of area under the drug concentration–time curve/MIC over 24 h (AUC0-24h/MIC > 100), and the risk of toxicity was estimated by drug trough concentration thresholds (1 and 2 mg/L). Results A one-compartment model adequately described the PK characteristics of gentamicin. Covariates including body weight, age, gender, and CRRT modality did not influence the PK parameters of gentamicin based on our dataset. All studied gentamicin regimens failed to achieve satisfactory PTAs for pathogens with an MIC ≥2 mg/L. A good balance of PK/PD target attainment and risk of toxicity (>2 mg/L) was achieved under 7 mg/kg gentamicin q24h and 40 mL/kg/h CRRT dose for an MIC ≤1 mg/L. CRRT dose intensity had a significant impact on the target attainment of AUC0-24h/MIC >100 and risk of toxicity. Conclusion A combination of 7 mg/kg gentamicin q24h and 40 mL/kg/h CRRT dose might be considered as a starting treatment option for CRRT patients, and drug monitoring is required to manage toxicity.
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Affiliation(s)
- Sha He
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410013, People's Republic of China
| | - Zeneng Cheng
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410013, People's Republic of China
| | - Feifan Xie
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410013, People's Republic of China
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6
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Matusik E, Boidin C, Friggeri A, Richard JC, Bitker L, Roberts JA, Goutelle S. Therapeutic Drug Monitoring of Antibiotic Drugs in Patients Receiving Continuous Renal Replacement Therapy or Intermittent Hemodialysis: A Critical Review. Ther Drug Monit 2022; 44:86-102. [PMID: 34772891 DOI: 10.1097/ftd.0000000000000941] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Antibiotics are frequently used in patients receiving intermittent or continuous renal replacement therapy (RRT). Continuous renal replacement may alter the pharmacokinetics (PK) and the ability to achieve PK/pharmacodynamic (PD) targets. Therapeutic drug monitoring (TDM) could help evaluate drug exposure and guide antibiotic dosage adjustment. The present review describes recent TDM data on antibiotic exposure and PK/PD target attainment (TA) in patients receiving intermittent or continuous RRT, proposing practical guidelines for performing TDM. METHODS Studies on antibiotic TDM performed in patients receiving intermittent or continuous RRT published between 2000 and 2020 were searched and assessed. The authors focused on studies that reported data on PK/PD TA. TDM recommendations were based on clinically relevant PK/PD relationships and previously published guidelines. RESULTS In total, 2383 reports were retrieved. After excluding nonrelevant publications, 139 articles were selected. Overall, 107 studies reported PK/PD TA for 24 agents. Data were available for various intermittent and continuous RRT techniques. The study design, TDM practice, and definition of PK/PD targets were inconsistent across studies. Drug exposure and TA rates were highly variable. TDM seems to be necessary to control drug exposure in patients receiving intermittent and continuous RRT techniques, especially for antibiotics with narrow therapeutic margins and in critically ill patients. Practical recommendations can provide insights on relevant PK/PD targets, sampling, and timing of TDM for various antibiotic classes. CONCLUSIONS Highly variable antibiotic exposure and TA have been reported in patients receiving intermittent or continuous RRT. TDM for aminoglycosides, beta-lactams, glycopeptides, linezolid, and colistin is recommended in patients receiving RRT and suggested for daptomycin, fluoroquinolones, and tigecycline in critically ill patients on RRT.
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Affiliation(s)
- Elodie Matusik
- Pôle Pharmacie & Pôle Urgences-Réanimation-Anesthésie, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Clément Boidin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Pharmacie, Pierre-Bénite
- Univ Lyon, Université Claude Bernard Lyon 1, EA 3738 CICLY - Centre pour l'Innovation en Cancérologie de Lyon, Oullins
| | - Arnaud Friggeri
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service d'Anesthésie, Médecine Intensive et Réanimation, Pierre-Bénite
- Univ Lyon, Université Claude Bernard Lyon, Faculté de Médecine Lyon Sud-Charles Mérieux, Oullins
- UMR CNRS 5308, Inserm U1111, Centre International de Recherche en Infectiologie, Laboratoire des Pathogènes Émergents
| | - Jean-Christophe Richard
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Service de Médecine Intensive Réanimation, Lyon
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR CNRS 5220, Inserm U1206, Villeurbanne, France
| | - Laurent Bitker
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Service de Médecine Intensive Réanimation, Lyon
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR CNRS 5220, Inserm U1206, Villeurbanne, France
| | - Jason A Roberts
- Faculty of Medicine the University of Queensland, University of Queensland Centre for Clinical Research
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes
| | - Sylvain Goutelle
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Service de Pharmacie
- Univ Lyon, Université Claude Bernard Lyon 1, ISPB-Faculté de Pharmacie de Lyon ; and
- Univ Lyon, Université Claude Bernard Lyon 1, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive Villeurbanne, France
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7
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Vossen MG, Pferschy S, Milacek C, Haidinger M, Karolyi M, Vass Z, Burgmann H, Maier-Salamon A, Wicha SG, Jäger W, Zeitlinger M, Stimpfl T, Wittek T, Thalhammer F. In vivo / in vitro Correlation of Pharmacokinetics of Gentamicin, Vancomycin, Teicoplanin and Doripenem in a Bovine Blood Hemodialysis Model. Front Pharmacol 2021; 12:702455. [PMID: 34248646 PMCID: PMC8264131 DOI: 10.3389/fphar.2021.702455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Elimination of a drug during renal replacement therapy is not only dependent on flow rates, molecular size and protein binding, but is often influenced by difficult to predict drug membrane interactions. In vitro models allow for extensive profiling of drug clearance using a wide array of hemofilters and flow rates. We present a bovine blood based in vitro pharmacokinetic model for intermittent renal replacement therapy. Methods: Four different drugs were analyzed: gentamicin, doripenem, vancomicin and teicoplanin. The investigated drug was added to a bovine blood reservoir connected to a hemodialysis circuit. In total seven hemofilter models were analyzed using commonly employed flow rates. Pre-filter, post-filter and dialysate samples were drawn, plasmaseparated and analyzed using turbidimetric assays or HPLC. Protein binding of doripenem and vancomycin was measured in bovine plasma and compared to previously published values for human plasma. Results: Clearance values were heavily impacted by choice of membrane material and surface as well as by dialysis parameters such as blood flow rate. Gentamicin clearance ranged from a minimum of 90.12 ml/min in a Baxter CAHP-170 diacetate hemofilter up to a maximum of 187.90 ml/min in a Fresenius medical company Fx80 polysulfone model (blood flow rate 400 ml/min, dialysate flow rate 800 ml/min). Clearance of Gentamicin vs Vancomicin over the F80s hemofilter model using the same flow rates was 137.62 mL vs 103.25 ml/min. Doripenem clearance with the Fx80 was 141.25 ml/min. Conclusion: Clearance values corresponded very well to previously published data from clinical pharmacokinetic trials. In conjunction with in silico pharmacometric models. This model will allow precise dosing recommendations without the need of large scale clinical trials.
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Affiliation(s)
- M G Vossen
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - S Pferschy
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Milacek
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Haidinger
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Mario Karolyi
- Department for Infectious Diseases, Sozialmedizinisches Zentrum Sued Kaiser-Franz-Josef-Spital, Wien, Austria
| | - Zoltan Vass
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Alexandra Maier-Salamon
- Department of Pharmaceutical Chemistry, Division of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - S G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - W Jäger
- Department of Pharmaceutical Chemistry, Division of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - T Stimpfl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - T Wittek
- University Clinic for Ruminants, University of Veterinary Medicine Vienna, Vienna, Austria
| | - F Thalhammer
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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8
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Aminoglycosides in Critically Ill Septic Patients With Acute Kidney Injury Receiving Intermittent Hemodialysis: A Multicenter, Observational Study. Clin Ther 2021; 43:1125-1131. [PMID: 34108081 DOI: 10.1016/j.clinthera.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Data on aminoglycoside stewardship in critically ill septic patients with acute kidney injury (AKI) needing intermittent hemodialysis (IH) are scarce. The first objective of the study was to evaluate whether aminoglycoside administration occurs before vs after IH in the real-life management of critically ill septic patients with AKI needing IH. The second objective was to assess the delay in achieving a potential reinjection window for a second dose of aminoglycoside, which should be obtained with a postdialysis vs predialysis regimen. METHODS A post hoc observational analysis of a multicenter randomized trial of critically ill patients with AKI needing renal replacement therapy was conducted. Inclusion criteria consisted of any patients receiving IH for AKI during an antimicrobial therapy for a septic episode. FINDINGS Among 206 of 341 septic patients (60%) receiving aminoglycosides, 90 underwent IH (46 with previous continuous renal replacement therapy and 44 without). Amikacin and gentamicin were administered for a mean (SD) of 2.2 (1.5) and 2.5 (2.1) days with mean (SD) doses of 20.6 (6.6) and 5.4 (2.5) mg/kg, respectively. In the 44 patients undergoing exclusive IH, aminoglycosides were administered in a predialysis in 53% of episodes versus 35% in a postdialysis schedule. The first Cmin target was obtained earlier with a predialysis vs postdialysis schedule (33.9 [14.2] hours vs 50.9 [12.2] hours, P = 0.009). IMPLICATIONS Despite being less frequently used than a predialysis schedule, the postdialysis administration of aminoglycosides remains a regular practice in the intensive care unit. A predialysis schedule of administration in IH reduces the interval time to tolerable aminoglycoside redosing.
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9
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Giroux M, Bouchard N, Henderson A, Lam L, Tran VAS, Projean D, Tessier JF, Lepage L, Gavra P, Ouellet G, Vallée M, Lafrance JP. Pharmacokinetics of Tobramycin Administered at the Beginning of Intermittent Hemodialysis Session (ESRD Study). Can J Kidney Health Dis 2021; 8:2054358120987061. [PMID: 33680482 PMCID: PMC7897820 DOI: 10.1177/2054358120987061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: There is a renewed interest in the successful use of aminoglycosides due to increasing resistance in gram-negative infections. Few studies to date have examined the pharmacokinetics (PK) of intradialytic infusions of tobramycin. This study sought to characterize the pharmacokinetic profile of intradialytically administered tobramycin in infected patients receiving chronic intermittent hemodialysis and to determine whether it is possible to achieve favorable PK targets. Design, Setting, Participants, and Measurements: In this prospective pharmacokinetic study, a single dose (5 mg/kg) of tobramycin was administered intradialytically to 11 noncritically ill patients undergoing chronic intermittent hemodialysis. Blood samples were collected at selected time to determine tobramycin serum concentrations. The PK analysis was performed using Phoenix™ NLME. The efficacy exposure outcome for nonsevere gram-negative infections sensitive to tobramycin with a minimum inhibitory concentration ≤1 were maximum concentration (Cmax ≥ 10 mg/L) and area under the curve (AUC24 h > 30 mg⋅h/L). For toxicity, the goal was to identify plasma trough concentrations <2 mg/L. Results: Tobramycin disposition was best described by a one-compartment model using a total clearance composed of the systemic clearance and a transitory hemodialysis clearance. Tobramycin mean (SD) Cmax, trough levels, and AUC24h were 13.1 (1.3) mg/L, 1.32 (0.47) mg/L, and 61 (23) mg⋅h/L, respectively. Monte Carlo simulation run with 1000 virtual patients showed that a 5 mg/kg dose of tobramycin administered intradialytically can outperformed the usual low-dose postdialysis dosing (80% meeting all targets versus <1%, respectively). Conclusions: A single high dose of tobramycin can achieve favorable PK outcome when administered using intradialytic infusions in hemodialysis patients. This practical dosing regimen may represent an effective and safer alternative to the usual dosing in the treatment of nonsevere gram-negative infections.
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Affiliation(s)
- Marjolaine Giroux
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Nicolas Bouchard
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Anik Henderson
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Lesly Lam
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Van Anh Sylvie Tran
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Denis Projean
- Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Jean-François Tessier
- Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Laurence Lepage
- Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Paul Gavra
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Georges Ouellet
- Université de Montréal, QC, Canada.,Service de Néphrologie, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Michel Vallée
- Université de Montréal, QC, Canada.,Service de Néphrologie, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Jean-Philippe Lafrance
- Service de Néphrologie, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada.,Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.,Département de pharmacologie et physiologie, Université de Montréal, QC, Canada
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10
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Jang SM, Lewis SJ, Mueller BA. Harmonizing antibiotic regimens with renal replacement therapy. Expert Rev Anti Infect Ther 2020; 18:887-895. [DOI: 10.1080/14787210.2020.1764845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Soo Min Jang
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Susan J. Lewis
- Department of Pharmacy Practice, University of Findlay College of Pharmacy, Findlay, OH, USA
| | - Bruce A. Mueller
- Clinical Pharmacy Department, Michigan College of Pharmacy, Ann Arbor, MI, USA
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11
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Population pharmacokinetics of gentamicin in haemodialysis patients: modelling, simulations and recommendations. Eur J Clin Pharmacol 2020; 76:947-955. [DOI: 10.1007/s00228-020-02867-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
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12
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Hoff BM, Maker JH, Dager WE, Heintz BH. Antibiotic Dosing for Critically Ill Adult Patients Receiving Intermittent Hemodialysis, Prolonged Intermittent Renal Replacement Therapy, and Continuous Renal Replacement Therapy: An Update. Ann Pharmacother 2019; 54:43-55. [PMID: 31342772 DOI: 10.1177/1060028019865873] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: To summarize current antibiotic dosing recommendations in critically ill patients receiving intermittent hemodialysis (IHD), prolonged intermittent renal replacement therapy (PIRRT), and continuous renal replacement therapy (CRRT), including considerations for individualizing therapy. Data Sources: A literature search of PubMed from January 2008 to May 2019 was performed to identify English-language literature in which dosing recommendations were proposed for antibiotics commonly used in critically ill patients receiving IHD, PIRRT, or CRRT. Study Selection and Data Extraction: All pertinent reviews, selected studies, and references were evaluated to ensure appropriateness for inclusion. Data Synthesis: Updated empirical dosing considerations are proposed for antibiotics in critically ill patients receiving IHD, PIRRT, and CRRT with recommendations for individualizing therapy. Relevance to Patient Care and Clinical Practice: This review defines principles for assessing renal function, identifies RRT system properties affecting drug clearance and drug properties affecting clearance during RRT, outlines pharmacokinetic and pharmacodynamic dosing considerations, reviews pertinent updates in the literature, develops updated empirical dosing recommendations, and highlights important factors for individualizing therapy in critically ill patients. Conclusions: Appropriate antimicrobial selection and dosing are vital to improve clinical outcomes. Dosing recommendations should be applied cautiously with efforts to consider local epidemiology and resistance patterns, antibiotic dosing and infusion strategies, renal replacement modalities, patient-specific considerations, severity of illness, residual renal function, comorbidities, and patient response to therapy. Recommendations provided herein are intended to serve as a guide in developing and revising therapy plans individualized to meet a patient's needs.
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Affiliation(s)
- Brian M Hoff
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - Jenana H Maker
- University of the Pacific Thomas J. Long School of Pharmacy and Health Sciences, Stockton, CA, USA.,University of California Davis Medical Center, Sacramento, CA, USA
| | - William E Dager
- University of California Davis Medical Center, Sacramento, CA, USA
| | - Brett H Heintz
- University of Iowa College of Pharmacy, Iowa City, IA, USA.,Iowa City Veterans Affairs (VA) Health Care System, Iowa City, IA, USA
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13
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Guisado-Gil AB, Herrera-Hidalgo L, Santos-Rubio MD, Gil-Sacaluga L, Molina J, Lepe-Jiménez JA, Camacho-Martínez P, Gil-Navarro MV. Gentamicin as Empirical Treatment in Hemodialysis Patients: Safety, Pharmacokinetics, and Pharmacodynamics. Ther Apher Dial 2019; 23:550-555. [PMID: 30980613 DOI: 10.1111/1744-9987.12810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/08/2019] [Accepted: 04/11/2019] [Indexed: 01/13/2023]
Abstract
The aim of this study was to describe the safety profile and pharmacokinetic/pharmacodynamic parameters in end-stage renal disease patients who received gentamicin as empirical treatment in catheter-related bacteremia when they showed infection signs, regardless of the timing of the next HD. Patients received gentamicin 3 mg/kg before blood culture extraction when they showed infection signs and regardless of the timing of next hemodialysis session. Serum concentrations were collected after the gentamicin administration (peak level) and before the next HD (trough level). Toxicities and adverse drug events were registered. The main pharmacokinetic/pharmacodynamic goal for Gram-negative infections was peak:minimum inhibitory concentration (MIC) ≥10. Sixteen patients were included. Nephrotoxicity was not assessed in this population, and no ototoxicity was found. According to microbial isolation and gentamicin susceptibility, the value of peak:MIC was 5.4 ± 2.0. The administration of gentamicin in these conditions was safe. Estimated pharmacokinetic values were consistent with previous studies and appropriate according to peak:MIC goal for Gram-negative organisms with MIC ≤1 mg/L.
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Affiliation(s)
- Ana B Guisado-Gil
- Department of Pharmacy, University Hospital Virgen del Rocio, Seville, Spain
| | | | | | - Luis Gil-Sacaluga
- Department of Nephrology, University Hospital Virgen del Rocio, Seville, Spain
| | - José Molina
- Department of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, Seville, Spain
| | - José A Lepe-Jiménez
- Department of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, Seville, Spain
| | - Pedro Camacho-Martínez
- Department of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, Seville, Spain
| | - María V Gil-Navarro
- Department of Pharmacy, University Hospital Virgen del Rocio, Seville, Spain
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14
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Llanos-Paez CC, Hennig S, Staatz CE. Population pharmacokinetic modelling, Monte Carlo simulation and semi-mechanistic pharmacodynamic modelling as tools to personalize gentamicin therapy. J Antimicrob Chemother 2017; 72:639-667. [PMID: 28062683 DOI: 10.1093/jac/dkw461] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Population pharmacokinetic modelling, Monte Carlo simulation and semi-mechanistic pharmacodynamic modelling are all tools that can be applied to personalize gentamicin therapy. This review summarizes and evaluates literature knowledge on the population pharmacokinetics and pharmacodynamics of gentamicin and identifies areas where further research is required to successfully individualize gentamicin therapy using modelling and simulation techniques. Thirty-five studies have developed a population pharmacokinetic model of gentamicin and 15 studies have made dosing recommendations based on Monte Carlo simulation. Variability in gentamicin clearance was most commonly related to renal function in adults and body weight and age in paediatrics. Nine studies have related aminoglycoside exposure indices to clinical outcomes. Most commonly, efficacy has been linked to a Cmax/MIC ≥7-10 and a AUC24/MIC ≥70-100. No study to date has shown a relationship between predicted achievement of exposure targets and actual clinical success. Five studies have developed a semi-mechanistic pharmacokinetic/pharmacodynamic model to predict bacteria killing and regrowth following gentamicin exposure and one study has developed a deterministic model of aminoglycoside nephrotoxicity. More complex semi-mechanistic models are required that consider the immune response, use of multiple antibiotics, the severity of illness, and both efficacy and toxicity. As our understanding grows, dosing of gentamicin based on sound pharmacokinetic/pharmacodynamic principles should be applied more commonly in clinical practice.
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15
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Jager NGL, Zandvliet AS, Touw DJ, Penne EL. Optimization of anti-infective dosing regimens during online haemodiafiltration. Clin Kidney J 2017; 10:282-290. [PMID: 28396747 PMCID: PMC5381234 DOI: 10.1093/ckj/sfx009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/30/2016] [Indexed: 12/13/2022] Open
Abstract
Online haemodiafiltration (HDF) is increasingly used in clinical practice as a routine intermittent dialysis modality. It is well known that renal impairment and renal replacement therapy can substantially affect the pharmacokinetic behaviour of several drugs. However, surprisingly few data are available on the need for specific dose adjustments during HDF. Due to convection, drug clearance may be increased during HDF as compared with standard haemodialysis. This may be of particular interest in patients undergoing anti-infective therapy, since under-dosing may compromise patient outcomes and promote the emergence of bacterial resistance. Drug clearance during HDF is determined by (i) dialysis characteristics, (ii) drug characteristics and (iii) patient characteristics. In this review, we will discuss these different determinants of drug clearance during HDF and advise on how to adjust the dose of antibacterial, antimycotic and antiviral agents in patients undergoing HDF. In addition, the possible added value of therapeutic drug monitoring is discussed. The review provides guidance for optimization of anti-infective dosing regimens in HDF patients.
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Affiliation(s)
- Nynke G L Jager
- Department of Clinical Pharmacy, Northwest Clinics, Alkmaar, The Netherlands; Department of Clinical Pharmacology and Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
| | - Anthe S Zandvliet
- Department of Clinical Pharmacology and Pharmacy, VU Medical Centre, Amsterdam, The Netherlands
| | - Daniel J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik L Penne
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
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16
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Abstract
We often administer dialyzable medications after dialysis to ensure that adequate concentrations are maintained in the body until the next session. In the case of aminoglycosides, we may have the opportunity to dose more aggressively predialysis, and then use the clearance of the drug by dialysis to limit toxicities. Predialysis aminoglycoside dosing is intriguing, although studies evaluating the safety and efficacy of this approach are necessary before it can be used routinely.
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Affiliation(s)
- Rachel Eyler
- Department of Pharmacy Practice, University of Connecticut, Storrs, Connecticut
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17
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18
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Eschenauer GA, Lam SW, Mueller BA. Dose Timing of Aminoglycosides in Hemodialysis Patients: A Pharmacology View. Semin Dial 2016; 29:204-13. [PMID: 26756428 DOI: 10.1111/sdi.12458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aminoglycosides for patients undergoing intermittent hemodialysis (IHD) have traditionally been dosed at half the normal dose administered at the end of a hemodialysis session. Several investigations have suggested that administering higher doses preceding or with the initiation of dialysis would more readily optimize pharmacodynamic parameters. However, the selection of an optimal aminoglycoside dosing strategy in patients receiving IHD is complex and requires consideration of numerous factors, precluding a singular approach. By reviewing aminoglycoside pharmacokinetics, pharmacodynamics, risks for toxicity and resistance development, and practical considerations, we derive indication- and setting- specific recommendations. We identify some areas (definitive therapy of gram-negative infections in patients receiving predictable hemodialysis sessions, for example) where dosing preceding or with the initiation of dialysis is optimal and feasible, and others (gram-positive synergy, unstable patients with poor/unpredictable vascular access) where postdialysis dosing remains preferred. Finally, given the dearth of data exploring the pharmacodynamics and clinical outcomes of IHD patients receiving aminoglycoside therapy, we identify several key questions in need of investigation.
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Affiliation(s)
- Gregory A Eschenauer
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Simon W Lam
- Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
| | - Bruce A Mueller
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
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19
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Keller F, Schröppel B, Ludwig U. Pharmacokinetic and pharmacodynamic considerations of antimicrobial drug therapy in cancer patients with kidney dysfunction. World J Nephrol 2015; 4:330-344. [PMID: 26167456 PMCID: PMC4491923 DOI: 10.5527/wjn.v4.i3.330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/12/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Patients with cancer have a high inherent risk of infectious complications. In addition, the incidence of acute and chronic kidney dysfunction rises in this population. Anti-infective drugs often require dosing modifications based on an estimate of kidney function, usually the glomerular filtration rate (GFR). However, there is still no preferential GFR formula to be used, and in acute kidney injury there is always a considerable time delay between true kidney function and estimated GFR. In most cases, the anti-infective therapy should start with an immediate and high loading dose. Pharmacokinetic as well as pharmacodynamic principles must be applied for further dose adjustment. Anti-infective drugs with time-dependent action should be given with the target of high trough concentrations (e.g., beta lactam antibiotics, penems, vancomycin, antiviral drugs). Anti-infective drugs with concentration-dependent action should be given with the target of high peak concentrations (e.g., aminoglycosides, daptomycin, colistin, quinolones). Our group created a pharmacokinetic database, called NEPharm, hat serves as a reference to obtain reliable dosing regimens of anti-infective drugs in kidney dysfunction as well as renal replacement therapy. To avoid the risk of either too low or too infrequent peak concentrations, we prefer the eliminated fraction rule for dose adjustment calculations.
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20
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Hunter AS, Guervil DJ, Perez KK, Schilling AN, Verheyden CN, Vuong NN, Xu R. Significant publications on infectious diseases pharmacotherapy in 2013. Am J Health Syst Pharm 2015; 71:1974-88. [PMID: 25349243 DOI: 10.2146/ajhp140148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The most important articles on infectious diseases (ID) pharmacotherapy published in the peer-reviewed literature in 2013, as nominated and selected by panels of pharmacists and others with ID expertise, are summarized. SUMMARY Members of the Houston Infectious Diseases Network were asked to nominate articles published last year in prominent biomedical journals that had a major impact in the field of ID pharmacotherapy. A list of 27 nominated articles on ID-related topics in general and 26 articles specifically focused on human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) was compiled. In a national online survey conducted in January 2014, members of the Society of Infectious Diseases Pharmacists (SIDP) were asked to select from the list those articles that they felt had made the greatest contributions to the field of ID pharmacotherapy. Of 168 SIDP members surveyed, 108 (64%) and 53 (32%) participated in the selection of ID- and HIV/AIDS-related articles, respectively. Summaries of the top-ranked articles in both categories are presented. CONCLUSION Major topics explored in the top-ranked ID articles of 2013 include the use of cefepime for gram-negative infections due to AmpC or extended-spectrum β-lactamase-producing Enterobacteriaceae, optimizing antibiotic therapy through the use of extended- or continuous-infusion regimens, the use of the oral integrase inhibitor dolutegravir to combat HIV disease, and new approaches to treatment of Clostridium difficile infection and enterococcal endocarditis.
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Affiliation(s)
- Andrew S Hunter
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - David J Guervil
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands.
| | - Katherine K Perez
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - Amy N Schilling
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - Collin N Verheyden
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - Nancy N Vuong
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - Ran Xu
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
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21
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Boyer A, Clouzeau B, M’zali F, Kann M, Gruson-Vescovali D. Comment utiliser les aminosides en réanimation. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1067-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Lewis SJ, Mueller BA. Antibiotic Dosing in Patients With Acute Kidney Injury: "Enough But Not Too Much". J Intensive Care Med 2014; 31:164-76. [PMID: 25326429 DOI: 10.1177/0885066614555490] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/25/2014] [Indexed: 12/21/2022]
Abstract
Increasing evidence suggests that antibiotic dosing in critically ill patients with acute kidney injury (AKI) often does not achieve pharmacodynamic goals, and the continued high mortality rate due to infectious causes appears to confirm these findings. Although there are compelling reasons why clinicians should use more aggressive antibiotic dosing, particularly in patients receiving aggressive renal replacement therapies, concerns for toxicity associated with higher doses are real. The presence of multisystem organ failure and polypharmacy predispose these patients to drug toxicity. This article examines the pharmacokinetic and pharmacodynamic consequences of critical illness, AKI, and renal replacement therapy and describes potential solutions to help clinicians give "enough but not too much" in these very complicated patients.
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Affiliation(s)
- Susan J Lewis
- Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Bruce A Mueller
- Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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23
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Venisse N, Dupuis A, Badin J, Robert R, Pinsard M, Veinstein A. Efficacy and safety of high-dose gentamicin re-dosing in ICU patients receiving haemodialysis. J Antimicrob Chemother 2014; 70:308-10. [PMID: 25239463 DOI: 10.1093/jac/dku369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nicolas Venisse
- Pharmacokinetics Department, University Hospital of Poitiers, Poitiers, France
| | - Antoine Dupuis
- Pharmacy Department and UMR CNRS 7285, University Hospital of Poitiers, Poitiers, France
| | - Julie Badin
- Medical Intensive Care Unit, University Hospital of Poitiers, Poitiers, France
| | - René Robert
- Medical Intensive Care Unit, University Hospital of Poitiers, Poitiers, France INSERM U927, University of Poitiers, Poitiers, France
| | - Michel Pinsard
- Medical Intensive Care Unit, University Hospital of Poitiers, Poitiers, France
| | - Anne Veinstein
- Medical Intensive Care Unit, University Hospital of Poitiers, Poitiers, France
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