Three-year experience with amikacin sulfate as an exclusive surgical aminoglycoside in a large acute-care hospital.
Aminoglycosides have important roles as perioperative adjunctive antibiotics in the surgical management of peritonitis. In the past, most surgeons have used gentamicin in combination with a drug aimed at intraperitoneal anaerobic pathogens, either clindamycin or metronidazole. Amikacin has been traditionally reserved for culture-proved infections due to gram-negative organisms resistant to gentamicin or other aminoglycosides. At the Minneapolis Veterans Administration Medical Center, a worrisome incidence of gentamicin-resistant hospital isolates led to a decision to make amikacin the exclusive, routine surgical aminoglycoside for all abdominal infections, as well as all hospital-acquired infections in surgical patients involving gram-negative aerobes and requiring parenteral therapy. This report describes the resultant three-year experience with amikacin in surgical patients. Data from four research studies involving these patients suggest that exclusive amikacin use has not led to the emergence of amikacin-resistant organisms or to significant nephrotoxicity. Amikacin use in surgical patients is supported in hospital environments where gentamicin resistance is judged to be a significant clinical risk factor.
D000005:Abdomen; D000038:Abscess / Q000188:drug therapy; D000583:Amikacin / Q000008:administration & dosage / Q000627:therapeutic use*; D000667:Ampicillin / Q000008:administration & dosage; D002437:Cefazolin / Q000627:therapeutic use; D002981:Clindamycin / Q000008:administration & dosage; D003428:Cross Infection / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005839:Gentamicins / Q000494:pharmacology; D006090:Gram-Negative Bacteria; D006746:Hospital Bed Capacity, 500 and over; D006787:Hospitals, Veterans; D006801:Humans; D007612:Kanamycin / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010403:Penicillin Resistance; D010538:Peritonitis / Q000188:drug therapy; D011183:Postoperative Complications / Q000188:drug therapy; D011292:Premedication; D013530:Surgical Wound Infection / Q000188:drug therapy*
D005839:Gentamicins; D002981:Clindamycin; D007612:Kanamycin; D000667:Ampicillin; D000583:Amikacin; D002437:Cefazolin