Serum level monitoring of aminoglycoside antibiotics. Limitations in intensive care unit-related bacterial pneumonia
L. M. Flint, J. Gott, L. Short, J. D. Richardson and H. C. Polk Jr
Serum aminoglycoside assays have been accepted as useful methods of
enhancing therapeutic efficacy in the treatment of intensive care
unit-acquired pneumonia and in avoiding aminoglycoside nephrotoxicity. We
prospectively studied 68 surgical patients with normal renal function and
gram-negative bacterial pneumonia who were treated with aminoglycosides.
Serum levels indicated subtherapeutic levels in 47 patients and verified
optimum levels in 13 patients. Toxic trough levels developed in six
patients and, despite immediate dosage adjustment, five patients suffered
nephrotoxicity. Six additional patients also had nephrotoxicity. Five of
these patients never had toxic peak or trough levels and rising trough
levels developed in one patient after serum creatinine levels began to
rise. We conclude that routine monitoring of serum levels effectively
detects subtherapeutic antibiotic levels. This modality is useful for
optimizing dosage schedules, but does not serve to predict or avoid
nephrotoxicity in critically ill surgical patients.
