Clinical predictors of subtherapeutic aminoglycoside levels in trauma patients undergoing once-daily dosing.
BACKGROUND
After publication of the Hartford nomogram in 1995, conflicting data have emerged regarding the use of once-daily aminoglycoside (ODA) regimens in critically ill patients. The purpose of this study was to characterize a trauma patient population with low 10-hour aminoglycoside levels (THL) within the Hartford ODA protocol.


METHODS
Patients admitted to a Level I trauma center who received aminoglycosides were eligible for study. Clinical and demographic data were prospectively collected. Patients were dosed according to the Hartford protocol and a THL was obtained. Patients with THL < 2.0 microg/mL (OFF cohort) were compared with those falling within the nomogram (ON cohort).


RESULTS
Of 79 patients receiving ODA therapy, 46 (58.2%) patients fell off the nomogram. The OFF cohort was associated with younger age and higher creatinine clearance, and related inversely to net resuscitative volume.


CONCLUSIONS
Trauma patients undergoing ODA therapy with low THL are younger and exhibit less net preaminoglycoside resuscitative volume and higher creatinine clearance. These findings may have important clinical implications regarding antibiotic efficacy in these select patients.
Toschlog
Eric A
EA
Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, 27858-4354, USA.
Blount
Kennedy P
KP
Rotondo
Michael F
MF
Sagraves
Scott G
SG
Bard
Michael R
MR
Schenarts
Paul J
PJ
Swanson
Melvin
M
Goettler
Claudia E
CE
D000328:Adult; D000367:Age Factors; D000368:Aged; D000617:Aminoglycosides / Q000008:administration & dosage* / Q000097:blood* / Q000493:pharmacokinetics; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood* / Q000493:pharmacokinetics; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D014947:Wounds and Injuries / Q000097:blood* / Q000628:therapy
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents