Effect of individualized pharmacokinetic dosing on patient outcome.
OBJECTIVE
To study the effect of individualized pharmacokinetic dosing of aminoglycosides on patient outcome.


METHODS
Prospective, randomized study.


METHODS
Tertiary care hospital.


METHODS
Ninety-five patients with documented Gram-negative infections received 97 courses of aminoglycoside therapy.


METHODS
Patients were randomized between pharmacokinetic dose adjustment and monitoring or traditional physician-directed techniques. Patients were stratified by severity of underlying illness before randomization.


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.
Whipple
J K
JK
Department of Surgery, Medical College of Wisconsin, Milwaukee.
Ausman
R K
RK
Franson
T
T
Quebbeman
E J
EJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D015982:Bias; D002423:Cause of Death; D016903:Drug Monitoring / Q000191:economics / Q000592:standards*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006784:Hospitals, Teaching; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014922:Wisconsin / Q000453:epidemiology
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents