Die Einmaldosierung von Aminoglykosiden bei unterschiedlicher Nierenfunktion in der Intensivmedizin
The empirical dosages of the aminoglycosides Tobramycin and Amikazin are tested retrospectively using a one-dosage application system on a collective of critically ill patients. This study is carried out in order to test whether the dosages of said aminoglycosides administered empirically result in changes to the renal clearance on the one hand. On the other hand the aim of the test is to ascertain whether the recommended therapeutic levels are reached or even exceeded. This study is a retrospective analysis of the data of 47 patients taken from a collective of 1106 patients based on a time frame of 17 month. In over 85 per cent of all cases a renal clearance deterioration can be excluded while administering aminoglycosides. In the collective given Tobramycin 86 per cent of all cases display no renal clearance deterioration during therapy. The results yielded for the group of patients given Amikazin show that 2 out of 5 patients suffer a renal clearance reduction. Considering the data of all patients one notices that 17 per cent of all cases display a – usually low – clearance reduction. Examining the peak and trough dosage levels reveals that the medication levels advocated in the appropriate literature as effective are not always reached. In 50 per cent of all cases belonging to the Tobramycin group a sufficiently peak dosage can be reached 1 hour after application of the drug. All cases in the Amikazin group reach an acceptable level of effectiveness. The group using Tobramycin exceeds the highest level of the standardised trough dosage in 17 per cent of all cases. As opposed to that it cannot be shown that the Amikazin group exceeds the peak level at all. Using the collective tested here it has not been possible to proof a correlation between clearance reductions and elevated peak or – more importantly – trough levels. It becomes obvious that when looking at the peak and trough levels the empirical dosage given to critically ill patients tends to be slightly under-dosed which is probably due to the fear of the side effects these substances may have when given in too high a dosage. However this under-dosing can be lethal as patients often have a vital indication with respect to the aminoglycoside therapy. Based on our data gathered retrospectively we therefore advise administering the following dosages of the aminoglycosides Tobramycin and Amikazin to patients with kidney failure in one single – shot. When measuring a renal clearance between 50 and 70 ml/min the Tobramycin application should be about 3 mg/kg. On the other hand should the dose of Tobramycin got reduced when measuring a renal clearance of 40 ml/min between 1,5 to 2,0 mg/kg and measuring a renal clearance below 40 ml/min to 1,5 mg/kg. By looking at Amikazin it is advisable to administer this drug when measuring a renal clearance between 50 to 70 ml/min to 15 mg/kg. By reduced renal clearance of 40 until 50 ml/min should be started with a dosage of 12 mg/kg. However the renal clearance is reduced below 40 ml/min this study has shown that the Amikazin dose of 10 mg/kg seems safely. A prospective evaluation of the suggested dosages is most certainly necessary. In addition to that it is advisable to conduct regular drug-monitoring – as of the 3rd injection at the latest. This monitoring should not be limited to patients suffering from renal failure. This allows the dosage to be adjusted according to the individual needs during the course of the therapy, which can reduce the occurrence of unwelcome toxic effects.
info:eu-repo/classification/ddc/610, Medizin, Aminoglykoside, Tobramycin, Amikazin, Niereninsuffizienz, Einmaldosierung, renale Clearance
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