Therapeutic drug monitoring of amikacin: quantification in plasma by liquid chromatography-tandem mass spectrometry and work experience of clinical pharmacists

Abstract

Objectives As part of the service provided by clinical pharmacists in our hospital, an assay for plasma amikacin quantification by liquid chromatography-tandem mass spectrometry (LC-MS/MS) has been established for clinical use since 2018. This study was undertaken to describe: (1) the establishment of this assay; (2) the application and results of the testing; and (3) the analysis and impact for patients. Methods The amikacin quantification assay was validated and the plasma amikacin concentration data were extracted and analysed. The clinical data for related patients were collected from electronic health and medical records. Results 121 plasma samples from 53 patients were included in this statistical analysis. The use of amikacin was mostly monitored in the intensive care unit and the haematology department, and the monitoring range of amikacin concentrations were about 0.1–57µg/mL. The main indications for amikacin concentration detection were combined medications, impaired renal function, or people over 65 years old, which may increase the incidence of adverse reactions. Amikacin prescribing decisions were diversified due to the combination of assay results and clinical disease progression, and the effective rate of amikacin administration was about 52.8% (28/53). Conclusions The assay for plasma amikacin concentration has been successfully established to monitor the clinical use of amikacin, and the assay results served as one of the references for amikacin prescribing decisions.

Metabolomics revealed mechanism for the synergistic effect of sulbactam, polymyxin-B and amikacin combination against Acinetobacter baumannii

“…The monotherapy treatment against this MDR isolate would have required a large plasma amikacin exposure. However, the risk of human toxicity increases when the steady-state trough amikacin concentration is greater than 10 mg/L ( Dijkstra et al, 2014 ; Xu et al, 2022 ). In this isolate, the combination of polymyxin-B/amikacin reduced amikacin MIC value from >128 μg/mL in monotherapy to 2–4 μg/mL with and without sulbactam, respectively ( Table 1 ).…”

Aminoglycoside heteroresistance inEnterobacter cloacaeis driven by the cell envelope stress response

“…Our results indicate that these concentrations would not only fail to sterilise the E. cloacae type-strain or clinical isolates ( Figures 1D, 2B ) but may also facilitate heretoresistant growth. Likewise, peak amikacin and tobramycin plasma concentrations range from 10-60 mg.L −1 and <10 mg.L −1 , respectively (41–43), neither of which is sufficient to sterilise E. cloacae in vitro . The increase in ceftraixone MIC in GAPEc is explained by the upregulation of the β-lactamase ampC ( Figure 3D , Supplementary Table S1-S2 ), presumably due to cell envelope stress.…”

Development and Validation of a Bioanalytical Method for Therapeutic Drug Monitoring of Amikacin in Human Plasma Using Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry

“…QC samples were prepared at four different concentration levels, 1, 3, 60, and 120 µg/ml respectively (fig. 1) [19,20]. The parameters used to determine the accuracy and precision values were the % differentiation (% Diff) and % coefficient of variation (% CV) values.…”