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Evaluation of Large Dose, Extended Interval Aminoglycoside Dosing Protocols Using Pharmacokinetic Data from 515 PatientsVu, Peter January 2011 (has links)
Class of 2011 Abstract / OBJECTIVES: The purpose of this study is to assess three published aminoglycoside dosing protocols (large-dose extended interval), to predict peak and trough concentrations of these protocols and to determine the percentage of patients with peak and trough concentrations within each protocol’s specified ranges.
METHODS: This study is a retrospective analysis of clinical data. A database of 515 patients is used to analyze the three different protocols. The variables in this database encompass patients’ age, height, actual body weight (ABW), sex, k, Vd, and dose. From these data, patients' peak and trough concentrations were determined using the three large large, extended interval dosing protocols.
RESULTS The results showed Nicolau protocol with the most potential of the three protocols. It had the highest percentages of patients with peak above 15 mg/L and a trough less than 0.5 mg/L. It also had the highest average peak of 19.1 mg/L with 69.9% of patients meeting the protocol’s specified peak range of 13 to 23 mg/L. CONCLUSION: The three examined protocols all showed a percentage of patients within the desired range. Of the three, Nicolau protocol I showed promising results with highest average peak, lowest average trough and high percentage of patients with concentrations within desired ranges. Its percentages above 15 mg/L and less than 0.5 mg/L are greater than protocols II and III. Nicolau dosing protocol may be best in achieving high peak and low trough concentrations.
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Modification of Diet in Renal Disease and Modified Cockcroft-Gault Formulas in Predicting Aminoglycoside EliminationBookstaver, P., Johnson, James W., McCoy, Thomas P., Stewart, David, Williamson, John C. 01 December 2008 (has links)
BACKGROUND: The Modification of Diet in Renal Disease (MDRD) formula and a modified version of the Cockcroft-Gault (CGm) formula adjusting for body surface area have been found to more accurately estimate glomerular filtration rate (GFR) compared with the original CG equation in specific patient populations. To date, the use of these formulas in determining drug dosage and estimating drug elimination has not been thoroughly investigated. OBJECTIVE: To evaluate the ability of the MDRD and CGm formulas to predict aminoglycoside elimination rate and clearance. METHODS: A 6-month prospective, noninterventional, pharmacokinetic study was conducted at a university teaching hospital. Patients receiving aminoglycoside antibiotics (amikacin, gentamicin, or tobramycin) were eligible for study inclusion. Predicted elimination rate and aminoglycoside clearance were calculated for each patient using the MDRD and CGm formulas. Actual (patient-specific) elimination rate and aminoglycoside clearance were calculated for each patient using measured aminoglycoside serum concentrations. Predictive ability of the formulas was compared through Spearman correlations and Student's t-tests. Accuracy of formula estimates was also evaluated. RESULTS: Seventy-one patients met study inclusion criteria; the majority (82%) were in an intensive care unit. The 6-variable MDRD formula was found to be a significantly better predictor of aminoglycoside clearance (p = 0.035) compared with CGm. There was no statistically significant difference between the 2 methods in predicting patient-specific elimination rates (p = 0.167). Among subgroups, the MDRD formula was a significantly better predictor of aminoglycoside clearance for patients with an estimated GFR less than 60 mL/min (p = 0.027). CONCLUSIONS: The 6-variable MDRD performs better than the CGm formula in predicting aminoglycoside clearance and may be considered as a tool in aminoglycoside dosing recommendations.
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