[Adaptive control of therapeutics using amikacin in very old patients: retrospective analysis of efficacy and toxicity].
The authors previously showed the precision of adaptive control of amikacin therapy in elderly patients. The present retrospective study evaluated the effects of such therapy on outcomes. 48 patients, aged 80 +/- 5 years, with estimated creatinine clearance (eCCR) of 48 +/- 15 ml/mn, received amikacin initial dosage of 13.3 +/- 3.5 mg/kg/d, alone or with other drugs. Efficacy outcomes were: E1 = changes in dosage during therapy; E2 = fever reduction within 3 days after therapy; E3 = eradication of infection by culture data; E4 = reduction of white blood cell count (WCB) to normal; E5 = overall recovery. Toxicity outcomes were: T1 = subjective ototoxicity; T2 = nephrotoxicity, variation of serum creatinine low (between 18 et 44 mumol/l) or high (over 0.5 mg/dl).


RESULTS
E1: final dose = 11.8 +/- 5.1 mg/kg/d (NS), 57% reduced, 33% increased, during 15.1 +/- 9.3 days in therapy, with 88% having effective peaks over 15 micrograms/ml. E2: fever reduced within 3 days 16/37; after 12/37; no change, 9/37. E3: cultures became negative, 13/28. E4: WBC fell early, 10/21; late, 7/21; no change, 2/21. E5: recovery 36; death, 8; change in therapy, 3. T1: no clinical signs of ototoxicity. T2: low(+), 9/51; low(-), 11/51; high(-), 7/51. final eCCR: 48 +/- 14 ml/mn (NS); no nephrotoxicity. These results suggest that adaptive control of amikacin regimens yields good efficacy and avoid toxicity in the Elderly. However, prospective controlled clinical trials should be done for confirmation.
Grillot
M
M
ADCAPT, Service Pharmaceutique, Hôpital A. Charial, Hospices Civils de Lyon, Francheville, France.
Maire
P H
PH
Confesson
M A
MA
Cogoluenhes
V
V
Pivot
C
C
Druguet
M
M
Courpron
P
P
Jelliffe
R W
RW
D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000097:blood / Q000627:therapeutic use / Q000633:toxicity*; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000188:drug therapy*; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies
D000583:Amikacin; D003404:Creatinine
Contrôle adaptatif des thérapeutiques par l'amikacine chez des patients très âgés: analyse rétrospective de l'efficacité et de la toxicité.