The use of extended-interval aminoglycoside dosing strategies for the treatment of moderate-to-severe infections encountered in critically ill surgical patients.
BACKGROUND
Extended-interval dosing strategies have been developed to exploit the concentration-dependent bactericidal activity and time-dependent host toxicity associated with aminoglycoside the therapy. The ability of published extended-interval dosing nomograms to achieve optimal pharmacodynamic endpoints may be limited in certain critically ill surgical patients.


METHODS
Review of pertinent English language literature. Presentation of descriptive, graded recommendations for extended-interval aminoglycoside dosing in critically ill surgical patients.


RESULTS
Aminoglycoside dosing considerations in critically ill surgical patients should attempt to maximize the bacterial and host pharmacodynamic attributes of these agents. Empirically, extended-interval aminoglycoside doses proposed by published nomograms are reasonable for most patients; however, because of clinically meaningful variations in aminoglycoside pharmacokinetics, routine use of published extended-interval aminoglycoside dosing nomograms to determine an appropriate dosage interval is discouraged in many critically ill surgical patients. Critically ill surgical patients receiving extended-interval aminoglycoside dosages should undergo individualized pharmacokinetic analysis to characterize efficiently and more effectively plasma concentration-to-bacterial minimum inhibitory concentration (MIC) relationships and determine an appropriate dosing interval, considering site and severity of infection, plasma clearance, and the apparent post-antibiotic effect.


CONCLUSIONS
The use of extended-interval aminoglycoside dosage regimens in critically ill surgical patients should be based on pharmacodynamic endpoints and patient-specific pharmacokinetic assessment.
Mueller
Eric W
EW
Department of Pharmacy Services, The University Hospital, Cincinnati, Ohio 45219-2316, USA. muelleew@healthall.com
Boucher
Bradley A
BA
D000617:Aminoglycosides / Q000008:administration & dosage* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D016638:Critical Illness; D006801:Humans
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents