title: [In the search for effective and safe dose of amikacin in patients with chronic kidney disease].
abstract: The aim of the study was to asses safe and effective amikacin (AMK) doses in patients with different stages of chronic kidney disease.
  
  
  METHODS
  The study included 25 patients, among them was 12 (48%) men and 13 (52%) women, aged 73.1 +/- 11.9 (38-89) years. AMK was applied in intravenous infusion during 10 days. The dosage was dependent on the stage of chronic kidney disease (CKD). Patients in stage 3A CKD (GFR 59--40 ml/min/1.73 m2) received 7.5 mg/kg/day, in stage 3B (GFR 39--30 ml/min/1.73 m2) received 4 mg/ kg m.c./day, in stage 4 (GFR 29--15 ml/min/1,73 m2) received 4 mg/ kg/day or 6.0 mg/kg every two days, in stage 5 treated with hemodialysis received 5 mg/kg every two days, in stage 5 treated with continuous ambulatory peritoneal dialysis received 4 mg/kg every two days. Trough levels of the drug (minimal level, before the next dose) and maximal levels (one hour after beginning of the infusion) were measured on day 3, 5, 9. Hearing tests were done twice, on day 1 and 9. Urine cultures were tested on day 1 and 5. Complicated urinary tract infections were the reasons of antibiotic treatment in 22 patients (88%). Other reasons were: sepsis (2 patients) and neutropenic fever (1 patient).
  
  
  RESULTS
  Average maximal level of the drug was 25.5 +/- 8.8 (9.6-50.4) microg/ml, average trough level was 3.1 +/- 2.9 (0.4-14.1) microg/ml. Bacterial eradication confirmed by negative culture was observed in 14 patients (56%). In patients with stage 4 CKD eradication was observed more often when AMK was used every day than every two days. Mean trough level was 6.9 +/- 5.5 microg/ml for every day dosage in comparison with 1.9 +/- 0.5 microg/ml for dosage every two days. Mean maximal level was 24.1 +/- 7.2 microg/ml for every day dosage and 21.8 +/- 5.8 microg/ml for every two days dosage.
  
  
  CONCLUSIONS
  Amikacin usage in described, lowered doses with prolonged interval between them is safe in terms of ototoxicity and nephrotoxicity in patients with chronic kidney disease. Every two days dosage is less effective than every day dosage in patients with stage 4 CKD. It can be a result of too lower minimal (trough) levels of the drug in serum. AMK trough levels are associated with effective therapy in patients with chronic kidney disease.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Gomółka
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Szamotulska
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Rymarz
authors.forename: Dorota
authors.initials: D
authors.lastname: Brodowska-Kania
authors.forename: Ivana
authors.initials: I
authors.lastname: Dubchak
authors.forename: Wiesław
authors.initials: W
authors.lastname: Piechota
authors.forename: Dariusz
authors.initials: D
authors.lastname: Jurkiewicz
authors.forename: Stanisław
authors.initials: S
authors.lastname: Niemczyk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D018805:Sepsis / Q000150:complications / Q000652:urine; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000652:urine; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin