Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 8;10(1):75.
doi: 10.1186/s13613-020-00685-5.

Amikacin pharmacokinetic/pharmacodynamic in intensive care unit: a prospective database

Elsa Logre  1 , Maya Enser  2 , Sébastien Tanaka  3   4 , Marie Dubert  5 , Aurore Claudinon  6 , Nathalie Grall  7 , Hervé Mentec  2 , Philippe Montravers  3 , Olivier Pajot  2
Affiliations

Amikacin pharmacokinetic/pharmacodynamic in intensive care unit: a prospective database

Elsa Logre et al. Ann Intensive Care. .

Abstract

Background: Aminoglycosides have a concentration-dependent therapeutic effect when peak serum concentration (Cmax) reaches eight to tenfold the minimal inhibitory concentration (MIC). With an amikacin MIC of 8 mg/L, the Cmax should be 64-80 mg/L. This objective is based on clinical breakpoints and not on measured MIC. This study aimed to assess the proportion of patients achieving the pharmacokinetic/pharmacodynamic (PK/PD) target Cmax/MIC ≥ 8 using the measured MIC in critically ill patients treated for documented Gram-negative bacilli (GNB) infections.

Methods: Retrospective analysis from February 2016 to December 2017 of a prospective database conducted in 2 intensive care units (ICU). All patients with documented severe GNB infections treated with amikacin (single daily dose of 25 mg/kg of total body weight (TBW)) with both MIC and Cmax measurements at first day of treatment (D1) were included. Results are expressed in n (%) or median [min-max].

Results: 93 patients with 98 GNB-documented infections were included. The median Cmax was 55.2 mg/L [12.2-165.7] and the median MIC was 2 mg/L [0.19-16]. Cmax/MIC ratio ≥ 8 was achieved in 87 patients (88.8%) while a Cmax ≥ 64 mg/L was achieved in only 38 patients (38.7%). Overall probability of PK/PD target attainment was 93%. No correlation was found between Cmax/MIC ratio and clinical outcome at D8 and D28.

Conclusion: According to PK/PD parameters observed in our study, single daily dose of amikacin 25 mg/kg of TBW appears to be sufficient in most critically ill patients treated for severe GNB infections.

Keywords: Amikacin; Intensive care unit; Pharmacodynamic; Pharmacokinetic.

PubMed Disclaimer

Conflict of interest statement

Dr. MONTRAVERS reports personal fees and non-financial support from Astellas, AstraZeneca, Basilea, Bayer, Cubist, Menarini, MSD, Parexel, Pfizer, Tetraphase and The Medicines Company unrelated to the submitted work. Dr PAJOT reports personal fees from MSD unrelated to the submitted work. No other disclosures were reported.

Figures

Fig. 1
Fig. 1
Flowchart of the study
Fig. 2
Fig. 2
Probability of achieving target Cmax/MIC ratio ≥ 8 according to the MIC
See this image and copyright information in PMC

References

    1. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999;115:462–474. doi: 10.1378/chest.115.2.462. - DOI - PubMed
    1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–377. doi: 10.1007/s00134-017-4683-6. - DOI - PubMed
    1. Moore RD, Lietman PS, Smith CR. Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimal inhibitory concentration. J Infect Dis. 1987;155:93–99. doi: 10.1093/infdis/155.1.93. - DOI - PubMed
    1. EUCAST. Aminoglycosides: http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_t....
    1. ANSM. Bon usage des aminosides administrés par voie injectable: gentamicine, tobramycine, netilmicine, amikacine – Mise au point 2011.

LinkOut - more resources