title: Aminoglycosides use in patients over 75 years old.
abstract: OBJECTIVE
  to describe aminoglycoside use and nephrotoxicity in patients older than 75 years.
  
  
  METHODS
  retrospective multicenter study.
  
  
  METHODS
  hospital department, rehabilitation, long-term care center.
  
  
  METHODS
  patients ≥75 years old treated by aminoglycosides.
  
  
  RESULTS
  184 patients, mean age: 84.4 years (range: 75-101). One hundred and twenty-seven patients received other nephrotoxic drug(s). Gentamicin (70%) and amikacin (30%) were used and the once-daily dosing was preferred (92%). Average treatment period was 2.75 (1-10) days for amikacin and 4.4 (1-30) for gentamicin with average dosage 13.5 and 3.5 mg/kg/day, respectively. The monitoring of maximal plasmatic concentration (Cmax) was done in 37 patients, 9 of them had probabilistic treatment. Only one had a Cmax fulfilling the objective of French recommendations (gentamicin >30 mg/l, amikacin >60 mg/l). When infection was documented, the objective of Cmax >10 × minimal inhibitory concentration of the strain was reached for 27%. Minimal plasmatic concentration was checked in 38% of cases, with adequate value (gentamicin <0.5 mg/l, amikacin <2.5 mg/l) for 37%. At the end of aminoglycoside course, 40 patients increased their serum creatinine >25% of the baseline value. In multivariate analysis, this was associated with treatment length ≥3 days and concomitant use of nephrotoxic drugs.
  
  
  CONCLUSIONS
  aminoglycosides dosing used in elderly patients probably need therapeutic drug monitoring and dose adjustment. Aminoglycosides are used to treat severe infections. One of the most important side effects is nephrotoxicity in oldest patients. To minimise nephrotoxicity, short treatments are necessary and avoiding others nephrotoxic drugs could be relevant.
authors.affiliation: CH Ales - CSGA, 811 Av Dr Jean Goubert, Ales 30100, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Fraisse
authors.affiliation: CH Ales - CSGA, 811 Av Dr Jean Goubert, Ales 30100, France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Gras Aygon
authors.affiliation: CHU Poitiers - Geriatric, Poitiers, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Paccalin
authors.affiliation: CH Annecy - Infectious Disease, Annecy, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Vitrat
authors.affiliation: CHU Caremeau - Geriatric, Nimes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: De Wazieres
authors.affiliation: CH Saumur - Geriatric, Saumur, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Baudoux
authors.affiliation: CHU Caremeau - Infectious Disease, Nimes, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lechiche
authors.affiliation: CHU Strasbourg - Infectious Disease, Strasbourg, France.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Vicens
authors.affiliation: CHU Caremeau - Infectious Disease, Nimes, France.
authors.forename: Albert
authors.initials: A
authors.lastname: Sotto
authors.affiliation: CH Annecy - Infectious Disease, Annecy, France.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Pagani
authors.affiliation: CH Annecy - Infectious Disease, Annecy, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Gaillat
authors.affiliation: CH Chambéry - Infectious Disease, Chambéry, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Forestier
authors.affiliation: University Hospital of Grenoble - University Clinic of Geriatric Medicine, BP 217, Grenoble 38043, France.
authors.forename: Gaëtan
authors.initials: G
authors.lastname: Gavazzi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D017723:Drug Utilization Review; D005260:Female; D005602:France; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents
keywords: aminoglycoside; oldest old; renal failure