Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department

Maarten Cobussen*, Patricia M. Stassen, Dirk Posthouwer, Frank H. van Tiel, Paul H. M. Savelkoul, Thomas Havenith, Michiel B. Haeseker

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Web of Science)

Abstract

Objective

To achieve an optimal effect in patients with sepsis at the emergency department (ED), the gentamicin peak-concentration should be sufficiently high (i.e. peak-concentration/MIC >= 8-10). ICU patients with sepsis often need higher gentamicin doses to achieve sufficiently high peak-concentrations. The aim of this study is to investigate which dose is needed to reach adequate peak-concentrations in patients presenting with sepsis at the ED.

Methods

Patients with sepsis at the ED were included from August 2015 until February 2017. Peak-concentrations were measured in blood 30 minutes after the first gentamicin dose. The study consisted of three phases. In the first phase, peak-concentrations were measured after a standard dose of 5mg/kg. In the second phase, a simulation ((peak-concentration/actual dose) x simulated dose) was performed to determine which dose was needed to reach adequate gentamicin peak-concentrations of >= 16mg/L. In the third phase, peak-concentrations were measured for the best simulated dose.

Results

In phase one, of 86 patients who received a dose of 5mg/kg, 34 (39.5%) patients did not reach the target peak-concentration of >= 16mg/L, and 73 (84.9%) did not reach >= 20mg/L. In phase two, the simulation showed that with a dose of 7mg/kg 83 (96.5%) patients would reach peak-concentrations >= 16mg/L, and 67 (77.9%) of >= 20mg/L. In phase three, 53 patients received a dose of 7mg/kg, of whom 45 (84.9%) reached peak-concentrations of >= 16mg/L, and 31 (58.5%) of >= 20mg/L.

Conclusion

Patients with sepsis at the ED need higher doses of gentamicin. A dose of 7mg/kg is needed to achieve adequate peak-concentrations in the majority of patients.

Original languageEnglish
Article number0210012
Number of pages10
JournalPLOS ONE
Volume14
Issue number1
DOIs
Publication statusPublished - 22 Jan 2019

Keywords

  • SEPTIC SHOCK
  • PHARMACOKINETICS
  • THERAPY
  • PROGRAM
  • DEFINITIONS
  • EXPERIENCE
  • RISK

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