title: A study to evaluate the first dose of gentamicin needed to achieve a peak plasma concentration of 30 mg/l in patients hospitalized for severe sepsis.
abstract: Previous studies have shown that the high dose of gentamicin (8 mg/kg) rarely achieves the desired peak plasma concentration (Cmax) of ≥30 mg/l in patients with severe sepsis or septic shock. The aim of this study was to determine the first dose of gentamicin needed to achieve a Cmax ≥ 30 mg/l. We conducted a prospective observational cohort study in one intensive care unit. All consecutive patients hospitalized for severe sepsis or septic shock and treated with a first dose of gentamicin >6 mg/kg were evaluated. During the study period, 15 of the 57 patients (26.3 %) treated with gentamicin had a Cmax ≥ 30 mg/l. The median dose of gentamicin administered was 8.9 [7.8-9.9] mg/kg. Independent factors in the multivariate analysis associated with a Cmax ≥ 30 mg/l were higher body mass index (per kg/m(2) increment) (OR: 1.173, 95%CI: 1.015-1.356, P = 0.03) and higher first dose of gentamicin (per mg/kg increment) (OR: 2.343, 95%CI: 1.346-4.08, P = 0.003). The optimal first dose to achieve a Cmax ≥ 30 mg/l was 11 mg/kg, with a specificity and a sensitivity of 100 % and 53.3 % respectively. These results suggest that a first dose of gentamicin >11 mg/kg is needed to achieve a Cmax ≥ 30 mg/l in most patients.
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405, Saint Denis, France. nicolas.allou@hotmail.fr.
authors.forename: N
authors.initials: N
authors.lastname: Allou
authors.affiliation: SAMU 974, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, 97405, Saint Denis, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Charifou
authors.affiliation: Département d'Anesthésie Réanimation, AP-HP, CHU Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Augustin
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405, Saint Denis, France.
authors.forename: T
authors.initials: T
authors.lastname: Galas
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405, Saint Denis, France.
authors.forename: D
authors.initials: D
authors.lastname: Valance
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405, Saint Denis, France.
authors.forename: L
authors.initials: L
authors.lastname: Corradi
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405, Saint Denis, France.
authors.forename: O
authors.initials: O
authors.lastname: Martinet
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405, Saint Denis, France.
authors.forename: D
authors.initials: D
authors.lastname: Vandroux
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405, Saint Denis, France.
authors.forename: J
authors.initials: J
authors.lastname: Allyn
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D015897:Comorbidity; D016903:Drug Monitoring; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins