title: Increased amikacin dosage requirements in burn patients receiving a once-daily regimen.
abstract: Altered pharmacokinetics in burn patients may affect antibiotic plasma concentrations. Typical once-daily dosing (ODD) of 15 mg/kg amikacin (AMK) in burn patients does not always produce peak concentrations (C(max)) reaching the therapeutic objective of six to eight times the minimal inhibitory concentration (MIC). We recorded plasma concentrations following administration of 20 mg/kg AMK in burn patients and studied factors affecting pharmacokinetics. Mean C(max) was 48.3+/-10.8 mg/L and the C(max)/MIC ratio was 6+/-1.35. Statistical analysis demonstrated a relationship between C(max) and the area of the burn and Unit Burn Standard, and between AMK clearance and creatinine clearance (Cl(CR)). We conclude that ODD regimens of AMK in patients with burns >15% body surface area and/or with Cl(CR) >120 mL/min could require doses >20 mg/kg to reach adequate C(max). In all cases, patient therapeutic drug monitoring is essential to ensure the safe usage of these dosing recommendations.
authors.affiliation: Service d'Anesthésie-Réanimation, Hôpital de Rangueil, Toulouse, France. conil.jm@chu-toulouse.fr
authors.forename: J M
authors.initials: JM
authors.lastname: Conil
authors.forename: B
authors.initials: B
authors.lastname: Georges
authors.forename: A
authors.initials: A
authors.lastname: Breden
authors.forename: C
authors.initials: C
authors.lastname: Segonds
authors.forename: M
authors.initials: M
authors.lastname: Lavit
authors.forename: T
authors.initials: T
authors.lastname: Seguin
authors.forename: N
authors.initials: N
authors.lastname: Coley
authors.forename: K
authors.initials: K
authors.lastname: Samii
authors.forename: G
authors.initials: G
authors.lastname: Chabanon
authors.forename: G
authors.initials: G
authors.lastname: Houin
authors.forename: S
authors.initials: S
authors.lastname: Saivin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics*; D002056:Burns / Q000150:complications / Q000378:metabolism; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012044:Regression Analysis; D014946:Wound Infection / Q000188:drug therapy* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin