title: Therapeutic monitoring of amikacin and gentamicin in critically and noncritically ill patients.
abstract: OBJECTIVE
  Therapeutic drug monitoring (TDM) enables individualization in the treatment to optimize clinical benefit and minimize drugs' side effects. Critically ill septic patients represent a challenge for antimicrobial treatment because of pathophysiological impact of sepsis on pharmacokinetics of drugs. The aim of this study was to assess the appropriateness of gentamicin and amikacin dosing in critically and noncritically ill patients, as well as to estimate the need for its regular therapeutic monitoring.
  
  
  METHODS
  It was a prospective study which included 31 patients on gentamicin and 16 patients on amikacin from four different units who met the inclusion criteria. Trough concentrations of drugs were measured in serum just before third or fourth dose of antibiotic, whereas peak concentrations were measured in serum 1 h after the completion of drug administration (steady state). Relevant data on patients' clinical course of disease, comorbidities, and concomitant medication were collected from medical charts in order to identify their possible influence on drugs' concentrations.
  
  
  RESULTS
  Peak concentrations of amikacin were in reference range in 81.8% critically ill and in 80% of noncritically ill patients (P = 0.931). Peak concentrations of gentamicin were in reference range in 88.9% critically ill and in 77.3% of noncritically ill patients (P = 0.457).
  
  
  CONCLUSIONS
  Serum concentrations of aminoglycosides (amikacin and gentamicin) were in reference range in most of the patients in our study, suggesting that dosing of these drugs in the University Hospital Clinical Center, Banja Luka, was adequate. In patients without kidney or liver disease, regular TDM of aminoglycosides is not necessary.
authors.affiliation: Department of Pharmacy, University Clinical Centre Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
authors.forename: Tijana
authors.initials: T
authors.lastname: Kovačević
authors.affiliation: Institute of Laboratory Diagnostics, University Clinical Centre Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
authors.forename: Sanja
authors.initials: S
authors.lastname: Avram
authors.affiliation: Department of Pharmacy, University Clinical Centre Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
authors.forename: Dragana
authors.initials: D
authors.lastname: Milaković
authors.affiliation: Department of Pharmacy, University Clinical Centre Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
authors.forename: Nikolina
authors.initials: N
authors.lastname: Špirić
authors.affiliation: Medical Intensive Care Unit, University Clinical Centre Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
authors.forename: Pedja
authors.initials: P
authors.lastname: Kovačević
keywords: Aminoglycosides; infection; therapeutic drug monitoring