title: [A priori prediction of gentamicin peak concentrations: Use of a simple and practical tool].
abstract: Aminoglycosides are concentration-dependent killing antibiotics, so that it is necessary to obtain elevated peak levels to reach the pharmacokinetic-pharmacodynamic objectives. Because of their nephrotoxicity, this class of antibiotics are frequently underprescribed and giving at an insufficient dosage when prescribed. That is why therapeutical drug monitoring (TDM) of aminoglycosides is recommanded to assess efficacy. Unfortunately, this TDM allows not a dosage adaptation on the first dose of aminoglycosides. The aim of the work was to elaborate a model using simple pharmacokinetics formulae to estimate gentamicin peak levels and so to propose an optimal a priori dosage on the first dose of gentamicin. The final model was tested out on 24 patients treated by gentamicin. The model was able to predict gentamicin peak levels in 62% of patients with a 10% precision and in 79% of patients with a 15% precision. Using this simple and practical tool might avoid under-dosage of gentamicin and clinical failure due to the selection of resistant bacteriae.
authors.affiliation: Service de pharmacie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Mignaval
authors.forename: P-A
authors.initials: PA
authors.lastname: Fontaine
authors.forename: A
authors.initials: A
authors.lastname: Riché
authors.forename: C
authors.initials: C
authors.lastname: Nowak
authors.forename: D
authors.initials: D
authors.lastname: Cancel
authors.forename: F
authors.initials: F
authors.lastname: Lemaitre
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000097:blood / Q000188:drug therapy; D001499:Bayes Theorem; D016903:Drug Monitoring / Q000379:methods*; D004351:Drug Resistance; D005839:Gentamicins / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D006801:Humans; D008954:Models, Biological; D009994:Osmolar Concentration
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins