The Use of Extended-Interval Aminoglycoside Dosing Strategies for the Treatment of Moderate-to-Severe Infections Encountered in Critically Ill Surgical Patients

Abstract

The use of extended-interval aminoglycoside dosage regimens in critically ill surgical patients should be based on pharmacodynamic endpoints and patient-specific pharmacokinetic assessment.

WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

“…The use of extended-interval aminoglycoside dosing strategies for the treatment of moderate-to-severe infections encountered in critically ill surgical patients [55,56]. …”

2013 WSES guidelines for management of intra-abdominal infections

“…Lower-than-standard dosages of renally excreted drugs must be administered in the presence of impaired renal function, while higher-than-standard dosages of renally excreted drugs may be required for optimal exposure in patients with glomerular hyperfiltration [249]. …”

“…Antibiotics such as quinolones, daptomycin, tigecycline, aminoglycosides, polienes, and echinocandins exhibit concentration-dependent activity; as such, the dose should be administered in a once-a-day manner (or with the lowest possible daily administrations) in order to achieve zenithal plasma levels [249]. …”

Simplified Estimation of Aminoglycoside Pharmacokinetics in Underweight and Obese Adult Patients

“…In patients with normal kidney function, traditional dosing includes use of 1 to 2 mg/kg of body weight dosed multiple times per day on the basis of renal function, while EIAD utilizes 5 to 10 mg/kg every 24 h (19,25). Therapeutic drug monitoring to individualize drug dosing should be used with either dosing approach to increase the probability of achieving specific target concentrations and reduce the risk of toxicity, especially among the critically ill (18,31). Traditional doses typically target a maximum concentration in plasma (C max ) of between 4 and 10 mg/liter and a detectable minimum concentration in plasma (C min ) of 0.3 mg/liter to Ͻ2 mg/liter, while EIAD targets a C max of 16 to 20 mg/liter and an undetectable C min (Ͻ0.3 mg/liter).…”