Individualized pharmacokinetic monitoring results in less aminoglycoside-associated nephrotoxicity and fewer associated costs.
OBJECTIVE
To examine the impact of individualized pharmacokinetic monitoring (IPM) on the development of aminoglycoside-associated nephrotoxicity (AAN).


METHODS
Retrospective case-control study.


METHODS
Two teaching hospitals.


METHODS
Two thousand four hundred five patients who received aminoglycosides.


METHODS
Aminoglycoside therapy dosed by either IPM or physicians' directions.


RESULTS
Patients receiving IPM were significantly less likely to develop AAN by both univariate (7.9% vs 13.2%, p=0.02) and multivariate methods (odds ratio 0.42, p=0.002). Female sex was protective against AAN. Age 50 years and above, high initial aminoglycoside trough, long duration of therapy, and concurrent piperacillin, clindamycin, or vancomycin increased risk of AAN. We estimated that IPM decreased AAN costs by $90,995/100 patients.


CONCLUSIONS
Individualized pharmacokinetic monitoring significantly decreased the frequency of AAN and its associated economic costs.
Streetman
D S
DS
Clinical Pharmacology Research Center, Bassett Healthcare, Cooperstown, New York, USA.
Nafziger
A N
AN
Destache
C J
CJ
Bertino
A S
AS
D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000191:economics / Q000493:pharmacokinetics; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood*; D017850:Economics, Pharmaceutical; D005260:Female; D005839:Gentamicins / Q000009:adverse effects / Q000191:economics / Q000493:pharmacokinetics; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014031:Tobramycin / Q000009:adverse effects / Q000191:economics / Q000493:pharmacokinetics
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D003404:Creatinine; D014031:Tobramycin