Abstract
Objective
The main aim of the trial was to determine the extent to which the volume of distribution of amikacin fluctuates in a seriously ill patient receiving copious quantities of i.v. fluid over an extended term of treatment. The impact of the volume fluctuation on amikacin therapeutic peak concentrations was also assessed.
Design and setting
The case report describes a young, previously healthy male adult admitted to the surgical ICU of a teaching hospital following trauma to the head and central nervous system.
Intervention
The patient received 1 g of amikacin once-daily i. v. for 35 consecutive days as part of an antimicrobial regimen. Blood samples were drawn for routine amikacin concentration determinations on 14 occasions, extending over the entire term of treatment, from which the required pharmacokinetic parameters were determined.
Results
The volume of distribution of amikacin varied extensively from 0.27 to 0.61 l/kg (normal range 0.27±0.06 l/kg) notwithstanding the fact that amikacin clearance remained satisfactorily high throughout the term of treatment.
Conclusions
Once-daily therapeutic amikacin concentrations fluctuate extensively and rapidly in the seriously ill patient receiving copious quantities of i.v. fluids, despite competent renal function. The volume expansion seen in our patient is difficult to account for in terms of the extracellular fluid compartment only.
Recommendations
(a) Once-daily regimen amikacin peak concentrations should be frequently monitored in the seriously ill patients; (b) once-daily amikacin regimens are best monitored using blood specimens drawn at 1 and 6–8 h post administration.
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References
Giamarellou H, Yiallouros K, Petrikkos G, Moschovakis E, Vavouraki E, Voutsinas D, Sfikakis, P (1991) Comparative kinetics and efficacy of amikacin administered once or twice daily in the treatment of systemic gram-negative infections. J Antimicrob Chemother 27 [Suppl C]: 73–79
Marik PE, Havlik I, Monteagudo FSE, Lipman J (1991) The pharmacokinetics of amikacin in critically ill adult and paediatric patients: comparison of onceversus twice-daily dosing regimens. J Antimicrob Chemother 27 [Suppl C]: 81–89
Nordström L, Ringberg H, Cronberg S, Tjernström O, Walder, M (1990) Does administration of an aminoglycoside in a single daily dose affect its efficacy and toxicity? J Antimicrob Chemother 25: 159–173
Laveso LA, Davis RL (1994) Two-versus three-sample method for estimating gentamicin pharmacokinetic values. Am J Hosp Pharm 51: 1021–1024
Gibaldi M, Perrier D (1982) Pharmacokinetics. In: Swarbrick J (ed) Pharmacokinetics. Dekker, New York Basel, pp 319–354
Van der Bijl P, De Stadler DR (1994) Amikacin determination using four different instruments. J Antimicrob Chemother 33: 672–673
Benet LZ, Williams RL (1990) Design and optimization of dosage regimens; pharmacokinetic data. In: Goodman AG, Rall TW, Nies AS, Taylor P (eds) Goodman and Gilman's—the pharmacological basis of therapeutics 8th edn. Pergamon Press, New York Oxford, p 1656
Beaucaire G, Leroy O, Beuscart C, Karp P, Chidiac C, Caillaux M (1991) Clinical and bacteriological efficacy, and practical aspects of amikacin given once daily for severe infections. J Antimicrob Chemother 27 [Suppl C]: 91–103
Barclay ML, Begg EJ, Hickling KG (1994) What is the evidence for once-daily aminoglycoside therapy? Clin Pharmacokinet 27: 32–48
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Botha, F.J.H., van der Bijl, P., Seifart, H.I. et al. Fluctuation of the volume of distribution of amikacin and its effect on once-daily dosage and clearance in a seriously ill patient. Intensive Care Med 22, 443–446 (1996). https://doi.org/10.1007/BF01712162
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DOI: https://doi.org/10.1007/BF01712162