Complexation versus hemodialysis to reduce elevated aminoglycoside serum concentrations

Abstract

Seven patients with acutely elevated aminoglycoside serum concentrations were studied comparing the effect of hemodialysis (n = 3) with removal by complexation using ticarcillin or carbenicillin (n = 4). Aminoglycoside serum half-life before intervention averaged 96 hours for the dialysis group and 67 hours for the complexation group. Ticarcillin was used for a minimum of 48 hours, while hemodialysis removal was estimated over 48 hours, which included two 4-hour dialysis periods. Aminoglycoside serum half-life was reduced to an average of 11 hours with hemodialysis, while with complexation using ticarcillin, it was reduced to 12 hours. During the 48-hour comparison period, complexation removed approximately 50% more aminoglycoside than did hemodialysis, primarily because the improved removal technique was sustained over the entire time. Complexation appears to be as effective as continuous hemodialysis in lowering excessive aminoglycoside serum concentrations. Complexation with ticarcillin can be more rapidly initiated, is less expensive and there is a low risk of adverse reactions. This method provides continued treatment of infections in patients with elevated serum concentrations and/or nephrotoxicity who require cessation of aminoglycoside therapy.