Usage pattern and serum level measurement of amikacin in the internal medicine ward of the largest referral hospital in the south of Iran: a pharmacoepidemiological study

Background: The inappropriate use of aminoglycosides has harmful effects such as the development of resistant pathogens and the incidence of nephrotoxicity and ototoxicity. Therefore, drug utilization evaluation of these drugs may improve their usage remarkably. The aim of this study was to assess the usage pattern of amikacin in an internal medicine ward

Methods: This cross-sectional study was conducted in the Internal Medicine Ward of Nemazee Teaching Hospital, Shiraz, Iran, in 2011. The guideline for amikacin use was approved by the institutional Pharmacy and Therapeutics Committee, and the study criteria were developed to assess several parameters involved in amikacin therapy such as appropriateness of drug use, dosage, duration of therapy, toxicity monitoring, and serum concentration assay. Serum concentration was assayed using a Cobas Mira AutoAnalyzer. Clinical and paraclinical parameters such as glomerular filtration rate, culture, microbial sensitivity, white blood cell count, and fever were collected

Results: Sixty-three patients were evaluated. Fifty-seven percent of the patients needed dose readjustment; however, it was not performed for 89% of them. Culture between 48 and 72 hours after amikacin administration was not controlled for 79% of the patients. In 19% of the patients, optimum therapeutic effect was not achieved. The mean+/-SD of the trough and peak concentrations was 7.63 +/- 5.4 microg/mL and 15.67 +/- 7.79 microg/mL, respectively. Forty-five percent of the trough and 38% of the peak levels were within the therapeutic range. The overall adherence of amikacin usage to the guideline was only 48%

Conclusion: To achieve appropriate treatment and prevent toxic effects, we recommend that pharmacokinetic dosing methods, amikacin guideline, and serum monitoring be considered

Preventing or attenuating amphotericin B nephrotoxicity with dopamine receptor agonists: a literature review

Nephrotoxicity is generally considered as the most clinically significant and dose-limiting adverse reaction of amphotericin B. Currently, only the clinical effectiveness of salt loading and administering lipid formulations of amphotericin B have been clearly demonstrated to prevent its nephrotoxicity. In this review, we collected the published data related to dopamine receptor agonists in preventing amphotericin B nephrotoxicity. A literature search was conducted by the relevant keywords like [amphotericin B], [nephrotoxicity, and [dopamine] in databases such as Scopus, Medline, Embase and ISI Web of Knowledge. Four relevant articles were considered. Results of all the 3 experimental studies demonstrated that co-administration of dopamine [0.5-10 microg/kg/min] as continuous intravenous infusion, SK and F R-105058 [10 mg/kg twice daily], a prodrug of fenoldopam, orally, or fenoldopam, a relatively selective dopamine receptor type 1 agonist, [0.5 or 1 microg/kg/min] as continuous intravenous infusion can at least significantly mitigate the decrease in creatinine clearance caused by amphotericin B. Furthermore, fenoldopam and SK and F R-105058 can also protect against or delay amphotericin B-induced tubular damages. In contrast, the only clinical trial published until now found that simultaneous continuous intravenous infusion of low dose dopamine [3 microg/kg/min] had no beneficial effects on the incidence, severity, as well as time onset of developing amphotericin B-induced nephrotoxicity in autologous bone marrow transplant and leukemia patients. Considering the lack of beneficial effects in different settings such as acute kidney injury of any cause, negative results of the only clinical trial, and risk of significant adverse reactions, continuous intravenous infusion of low dose dopamine [1-3 microg/kg/min] or selective dopamine receptor type 1 agonists [e.g., fenoldopam] currently appears to have no real clinical role in preventing or attenuating amphotericin B nephrotoxicity

Antitetanus toxoid antibody titer of chronic hemodialysis patients in Iran

Patients with end stage renal disease have higher incidence of infection diseases that is thought to be related to impaired immune system. To determine the antitetanus IgG antibody level in Iranian hemodialysis patients with end stage renal disease and to find its association with sex, age, blood hemoglobin, serum albumin, duration of dialysis, time of dialysis per week, dialysis adequacy, erythropoietin, or iron supplementation, body mass index [BMI] and underlying renal disorder. We conducted a cross sectional study on a total of 108 Iranian hemodialysis patients with end stage renal disorder, and 36 healthy individuals in the control group matched with the patient group. The patients and controls did not receive any antitetanus vaccine or immunoglobulins a year prior to the investigation. The serum antitetanus IgG antibody levels were measured by an ELISA method. We found 74.3% of patients to have unprotected antitetanus IgG antibody level compared with 52.8% of the control group. Except hemodialysis duration, none of the contributing factors seemed to affect immunity. We conclude that in our study, there is a significant difference in the antitetanus IgG antibody level between hemodialysis patients and the control group and also in the chronic hemodialysis patients

booster phenomenon of tuberculin skin testing in patients receiving hemodialysis

The risk of developing tuberculosis is high among chronic hemodialysis patients. The tuberculin skin test [TST] has been in use for diagnosing latent TB, but few data are available on TST in hemodialysis patients. This study was done to identify the TST reactivity and frequency of booster effect in serial TST among hemodialysis patients. A total of 100 patients in three hemodialysis centers were prospectively tested. Patients with less than 10mm indurations were given additional TST one and four weeks later to determine the frequency of booster effect. The cumulative prevalence of a positive TST was 7% for the first test and 16% for the third test. There was a weak, but significant correlation between TST positivity, serum albumin level, urea reduction ratio and KT/V [p<0.05]. There was no influence of age, gender, hemodialysis duration and primary renal disease. This study showed that the TST reactivity and booster effect among our hemodialysis patients in Iran are lower than in other societies. Inadequate hemodialysis and poor nutrition may contribute to the lower tuberculin skin test reactivity in our hemodialysis patients