Can pharmacokinetic dosing decrease nephrotoxicity associated with aminoglycoside therapy.

Abstract

A randomized, controlled clinical trial was performed to determine whether individualized dosing by use of Bayesian pharmacokinetic modeling could decrease nephrotoxicity accosted with aminoglycoside therapy. Two hundred forty-three patients receiving aminoglycosides for suspected or proven infection were randomly assigned to one of three groups: usual physician-directed dosing (Group 1), pharmacist-assisted dosing (Group 2), or pharmacist-directed dosing (Group 3). Dosing in Groups 2 and 3 was based on a Bayesian pharmacokinetic dosing program, whereas Group 1 served as the control group. Individualized dosing resulted in higher mean postinfusion (peak) serum aminoglycoside levels, higher ratios of mean peak level to minimum inhibitory concentration (peak/MIC ratios), and a trend toward lower trough serum levels. Milligrams per dose were higher and number of doses per day was lower in the pharmacist-dosed groups. However, the incidence of nephrotoxicity (> or = 100% increase in serum creatinine) was not different among the three groups (16, 27, and 16% in Groups 1, 2, and 3, respectively). Similarly, severity of toxicity was not affected by the dosing intervention. Risk factors for toxicity included duration of therapy, shock, treatment with furosemide, older age, and liver disease. After controlling for these factors, the dosing intervention still had no effect on nephrotoxicity. It was concluded that Bayesian pharmacokinetic dosing did not decrease the risk of nephrotoxicity associated with aminoglycoside therapy.

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

“…If the dose of aminoglycosides is optimized following TDM rather than being administered at the standard dose, an appropriate concentration can be achieved within the therapeutic range in addition to cost saving [ 56 171 ], and renal toxicity, length of hospitalization, and mortality rate can also be reduced [ 56 172 ]. In addition, PK/PD-based administration such as once-daily administration was also effective for alleviating renal toxicity and even improved clinical outcomes in some studies [ 173 174 ].…”

Effects of carbonated beverage and fruit juice on salivary pH among children in orphanage of Bareilly city: an in vivo study

“…Pleasure after consumption and taste are the reasons that lead children to drink these beverages. 4 Parents are the chief caretakers and saviors of a child but sadly thousands of children have to lead their lives without parents. Children living without parents because of their parents being deceased or incapable of bringing up their children, such segment of the society is called as 'orphans'.…”

Zebrafish (Danio rerio) larvae as a predictive model to study gentamicin-induced structural alterations of the kidney

“…For instance, nephrotoxic side effects are common in patients treated with the antibiotic drug gentamicin. In 50% of patients, signs of nephrotoxicity can be detected after 14 days of drug therapy [ 2 , 3 ]. Gentamicin-induced nephrotoxicity is thus clinically relevant and was described as a class effect of aminoglycosides leading to acute kidney injury [ 4 ].…”