4CPS-071 Therapeutic drug monitoring and safety of high-dose amikacin in critically ill patients

BackgroundPharmacokinetic parameters are altered in critically ill patients, such as an increase in volume of distribution of hydrophillic drugs. Peak plasma levels of amikacin, a concentration-dependent antibiotic, could be reduced in critically ill patients. Therefore, current recommendations incl...

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Published in:European journal of hospital pharmacy. Science and practice 2018-03, Vol.25 (Suppl 1), p.A74-A75
Main Authors: Barcelo, J, Fernández-Sala, X, Marin-Casino, M, Grau, S
Format: Article
Language:English
Subjects:
Drug dosages
Renal replacement therapy
Section 4: Clinical pharmacy services
Sepsis
Online Access:Get full text
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Summary:BackgroundPharmacokinetic parameters are altered in critically ill patients, such as an increase in volume of distribution of hydrophillic drugs. Peak plasma levels of amikacin, a concentration-dependent antibiotic, could be reduced in critically ill patients. Therefore, current recommendations include higher doses of amikacin (above 20 mg/kg/day) in critically ill patients in order to achieve therapeutic plasma levels, which means a possible higher incidence of adverse events, such as nephrotoxicity and ototoxicity. Therapeutic drug monitoring (TDM) and pharmacist intervention can be necessary in this type of patient to prevent these adverse effects.PurposeTo assess the impact of TDM in critically ill patients receiving high-dose amikacin.ResultsAbstract 4CPS-071 Table 1N 28 Sex (males) 18 (64.3) Age (years) 76.5 (72–80) Weight (kg) 75 (63.3–85.5) BMI (kg/m2) 27.4 (24.8–32.1) Adjusted weight (kg) 69.2 (60.8–75.1) SOFA score 4 (3–6) Sepsis (n) 20 (71.4) Septic shock (n) 3 (10.7) Dosage (mg/kg/24 hour) 21.5 (20–25) Supratherapeutic peak (>50 mcg/ml) (n) 21 (75) Supratherapeutic trough (>1 mcg/ml) (n) 22 (78.6) SCr (initial) (mg/dL) 0.76 (0.65–0.85) SCr (worst) (mg/dL) 1.1 (0.87–1.23) GFR (initial) (ml/min) 88 (77.9–90.1) GFR (worst) (ml/min) 59 (46–72.8) RIFLE (SCr) (no damage-risk-injury-failure) 17 (60.7)–6 (21.4)–3 (10.7)–2 (7.1) RIFLE (GFR) (no damage-risk-injury-failure) 13 (46.4)–11 (39.4)–2 (7.1)–2 (7.1) Day worst SCr/GFR value (n) 2 (1–4.3) Interval Increase (n): 20 (71.4)Maintain (n): 5 (17.9)Reduce (n): 1 (3.6)Stop (n): 2 (7.1) Dose Reduce (n): 19 (67.9)Maintain (n): 6 (21.4)Increase (n): 1 (3.6)Stop (n): 2 (7.1) Material and methodsRetrospective descriptive study performed in a 400-bed tertiary hospital. Data from patients receiving above 20 mg/kg/day amikacin between January 2014 to August 2017 were included. Patients with a glomerular filtration rate (GFR) below 40 ml/min or receiving renal replacement therapy were excluded. An intermediate level (10 hour post-administration) was used to extrapolate almost all peak and trough levels. Peak levels above 50 mcg/ml and trough levels above 1 mcg/ml were considered supratherapeutic. Data collected: demographic, body mass index (BMI), SOFA score (first 24 hours of amikacin therapy), sepsis, dosage, data extraction levels, renal function (values of serum creatinine (SCr) and GFR the first 24 hours of amikacin therapy and worst values during amikacin therapy) and TDM recommendation. Categorical variable
ISSN:2047-9956
2047-9964
DOI:10.1136/ejhpharm-2018-eahpconf.162