title: Impact of 30 mg/kg amikacin and 8 mg/kg gentamicin on serum concentrations in critically ill patients with severe sepsis.
abstract: OBJECTIVE
  Low first-dose peak serum concentrations of amikacin and gentamicin are commonly reported in ICU patients. The present study aimed to assess whether 30 mg/kg amikacin or 8 mg/kg gentamicin achieved target concentrations in ICU patients with severe sepsis.
  
  
  METHODS
  Sixty-three ICU patients (Simplified Acute Physiology Score II = 43 ± 16) with severe sepsis and an indication for intravenous amikacin (n = 47) or gentamicin (n = 16) were included. The first (30 mg/kg amikacin; 8 mg/kg gentamicin) and subsequent doses and corresponding peak concentrations (30 min after the completion of an infusion) were recorded. French guideline target concentrations were ≥60 and ≥30 mg/L for amikacin and gentamicin, respectively. A target pharmacokinetic/pharmacodynamic ratio of 10 × MIC was also measured.
  
  
  RESULTS
  Pulmonary, abdominal and urinary tract infections were diagnosed in 56 patients. Infection was confirmed in 37 patients (59%). The targeted first-dose peak concentration was achieved in 37/63 patients (59%) [amikacin 36/47 (77%) and gentamicin 1/16 (6%)], and 59/63 patients (94%) achieved the pharmacokinetic/pharmacodynamic ratio using the MIC data that were available from 21 patients. However, the second dose of aminoglycoside was withheld because of high trough concentrations in nearly half of patients who did not have renal dysfunction.
  
  
  CONCLUSIONS
  In this study, 30 mg/kg amikacin and 8 mg/kg gentamicin led to target peak serum concentrations in 59% of patients.
authors.affiliation: Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France EA 2992, Université de Montpellier, Faculté de Médecine Montpellier Nîmes, Chemin du Carreau de Lanes, 30 908 Nîmes cedex 02, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Roger
authors.affiliation: Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France.
authors.forename: Bastian
authors.initials: B
authors.lastname: Nucci
authors.affiliation: Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France EA 2992, Université de Montpellier, Faculté de Médecine Montpellier Nîmes, Chemin du Carreau de Lanes, 30 908 Nîmes cedex 02, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Louart
authors.affiliation: Service de Réanimation, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Friggeri
authors.affiliation: Service de Pharmacie, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France.
authors.forename: Haroun
authors.initials: H
authors.lastname: Knani
authors.affiliation: Laboratoire de Biochimie, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Evrard
authors.affiliation: Service de Microbiologie, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France INSERM, U1047, Université de Montpellier, Chemin du Carreau de Lanes, 30 908 Nîmes Cedex 02, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lavigne
authors.affiliation: Service de Réanimation, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
authors.affiliation: Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France EA 2992, Université de Montpellier, Faculté de Médecine Montpellier Nîmes, Chemin du Carreau de Lanes, 30 908 Nîmes cedex 02, France jean-yves.lefrant@wanadoo.fr.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
authors.affiliation: Burns Trauma and Critical Care Research Centre, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Brisbane 4029, Australia.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
authors.affiliation: Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes cedex 9, France EA 2992, Université de Montpellier, Faculté de Médecine Montpellier Nîmes, Chemin du Carreau de Lanes, 30 908 Nîmes cedex 02, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Muller
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D016638:Critical Illness; D005260:Female; D005602:France; D005839:Gentamicins / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018805:Sepsis / Q000188:drug therapy*; D044967:Serum / Q000737:chemistry; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000583:Amikacin