title: Therapeutic drug monitoring of aminoglycosides in acute myeloid leukaemia patients.
abstract: International guidelines limit the use of aminoglycosides in febrile neutropenia to severe situations. We retrospectively reviewed the use of aminoglycosides in adult acute myeloid leukaemia patients admitted in 2009. Our guidelines include precise indications (severe sepsis, shock, drug resistance), dosing regimens (once-daily 20 mg/kg/day amikacin, 5 mg/kg/day gentamicin), durations of treatment, drug monitoring timing, and target C(max) concentrations (40 mg/l amikacin, 20 mg/l gentamicin). Thirty-one patients received 46 aminoglycoside courses: 31 amikacin and 15 gentamicin. The mean prescribed dosage was 19 ± 2.8 mg/kg/day for amikacin and 4.7 ± 0.9 mg/kg/day for gentamicin. The mean duration of use was 2.9 days for both drugs. The mean C(max) for amikacin was 47 ± 13 mg/l and for gentamicin was 13.6 ± 7.5 mg/l. In compliant regimens, all amikacin patients and a third of gentamicin patients had adequate C(max). Among 23 isolated pathogens, 65.5% were susceptible to both drugs and 11.5% to amikacin only. This vindicates the 20 mg/kg/day amikacin dosage and suggests a need to increase the gentamicin dosage.
authors.affiliation: Pharmacie Centrale, CHRU, Lille, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Mareville
authors.forename: Julie
authors.initials: J
authors.lastname: Gay
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cliquennois
authors.forename: Charles
authors.initials: C
authors.lastname: Herbaux
authors.forename: Florence
authors.initials: F
authors.lastname: Pasquier
authors.forename: Delphine
authors.initials: D
authors.lastname: Allorge
authors.forename: Nicolas
authors.initials: N
authors.lastname: Blondiaux
authors.forename: Céline
authors.initials: C
authors.lastname: Berthon
authors.forename: Serge
authors.initials: S
authors.lastname: Alfandari
mesh_terms: D000328:Adult; D000368:Aged; D000583:Amikacin / Q000008:administration & dosage / Q000627:therapeutic use; D000617:Aminoglycosides / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000517:prevention & control; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000583:Amikacin