Rationality of administered gentamicin dose in cerebral coma patients treated in an intensive care unit.

Gentamicin is still widely used in the treatment of patients in an intensive care unit (ICU). The efficacy of aminoglycosides correlates with the peak serum concentration (Cmax), and the toxicity with the minimum serum concentration (Cmin). The aim of this study was to determine Cmax and Cmin in serum of cerebral coma ICU patients when a dosage of gentamicin of 5 mg/kg body weight was administered once daily; to evaluate the rationality of mentioned dose; and to identify factors associated with these concentrations. Material and METHODS. A total of 24 ICU patients suffering from cerebral coma were included into this analysis. A dosage of gentamicin of 5 mg/kg body weight was administered once a day. Gentamicin concentrations were tested twice after the first dose infusion (immediately and 5 hours after 1-hour infusion). Cmax, Cmin, volume of distribution (Vd), and elimination half-life (T1/2) were obtained. RESULTS. The mean Cmax was 17.96 (SD, 4.31) µg/mL (range, 10.30-27.87 µg/mL). The desirable Cmax (≥ 20 µg/mL) was reached only in 6 patients (25%). Cmin was calculated using a special pharmacokinetic program "Kinetica." Cmin of 0.5 µg/mL was not exceeded in any patient. A correlative analysis indicated a significant inverse direct correlation between Cmax and Vd and between Cmax and treatment duration in the ICU. An inverse correlation was observed between Cmin and T1/2, evaluation of coma according to the Glasgow coma scale, and creatinine clearance. CONCLUSIONS. A dosage of 5 mg/kg body weight once a day was not sufficient in cerebral coma ICU patients. This dose was not associated with the nephrotoxic effect of gentamicin (additional risk factors were absent). It is recommended to obtain gentamicin concentration at two time points following administration of the first dose (e.g., immediately after 1-hour infusion and 5 hours later), and using a special pharmacokinetic software, to calculate a necessary dose and interval of administration.

[Administration and dosing of gentamicin (data from Kaunas University of Medicine Hospital)]. / Gentamicino vartojimo ir dozavimo tyrimas (Kauno medicinos universiteto kliniku duomenys).

UNLABELLED: The aim of the study was to analyze the treatment with gentamicin and possible nephrotoxicity of this antibiotic in patients treated in surgical and internal medicine departments of Kaunas University of Medicine Hospital. MATERIALS AND METHODS: A total of 105 case histories obtained from archive of our hospital were analyzed: 59 case records from surgical and 46 from internal medicine departments. Data were collected regarding indications for the administration of gentamicin, its dosage, duration of treatment, and patients' renal function at the beginning and during the treatment. RESULTS: There were more than 30% of patients older than 65 years. Gentamicin was administered in 14 (23.73%) surgical inpatients to prevent postoperative infection; 45 (76.27%) surgical and 46 (100%) internal medicine inpatients received gentamicin because of symptoms of infection. Half of the patients were treated empirically. In 87.62% of cases, gentamicin was administered at a dose of 240 mg; all 105 patients received it once per day. Before treatment, renal function was not evaluated in 11.86% of surgical and in 19.56% of internal medicine inpatients, and during treatment, it was examined only in one-third of patients. The duration of the treatment was 5.932+/-2.392 days (range 2-13 days) in surgical and 8.283+/-3.344 days (range 3-19 days) in internal medicine inpatients. CONCLUSIONS: More than half of patients received empirical treatment with gentamicin. Not enough attention has been paid to the evaluation of renal function before and during treatment. The duration of treatment was too long.

[Assessment of antibiotic use and comparison with recommendations for their rational use]. / Antimikrobiniu vaistu vartojimo ivertinimas ir palyginimas su ju racionalaus vartojimo rekomendacijomis.

Irrational and excessive use of antibiotics increases resistance to these preparations. Antimicrobial resistance is a serious public health problem worldwide. The main goal of our study was to evaluate the use of antibiotics (indications, dosage, and treatment duration) in daily family doctors' practice and nonadherence to guidelines on rational antibiotic therapy. A retrospective study of records regarding the prescription of antibiotics for patients in two outpatient settings during the period of January 1, 2005, to December 31, 2005 was performed in Clinic of Family Medicine at Kaunas University of Medicine. Rationality of antibiotic therapy was evaluated according for adherence to published guidelines. A descriptive and comparative statistical analysis of data was processed with SPSS 13.0 program. There were 2935 patients in both outpatient settings (1285 and 1650, respectively). During the period of January 1, 2005, to December 31, 2005, antibiotics were prescribed in 210 cases for various reasons (71 (33.8%) and 139 (66.2%), respectively). A total of 184 (6.3%) patients received antibiotic therapy. It was determined that only in 9.5% of all cases, antibiotics were administered in keeping with the recommendations for rational antibiotic therapy. Only two treatment cases (1%) were based on bacteriological analysis. According to indications, appropriate antibiotics were prescribed in 42.9% of cases. The dosage of antibiotics was adjusted properly in 56.2% of cases, and even in 82.9% of cases, the duration of antibiotic therapy fulfilled the guidelines on rational antibiotic use. More rational antibiotic therapy was practiced in the second outpatient setting (10.8%) compared to the first outpatient setting (7%) (p<0.05). The most irrationally antibiotics were prescribed for the treatment of urinary tract and ocular infections.

[Irrational drug use in Siauliai, Panevezys and Utena counties of Lithuania]. / Neracionalaus vaistu vartojimo problemos Siauliu, Panevezio bei Utenos apskrityse.

UNLABELLED: In our study, we aimed to investigate the irrational use of the reimbursed drugs in some counties of Lithuania in 2001 by investigating the viewpoints of the physicians to the problems of the irrational pharmacotherapy, possible causes and solutions of them. This investigation was designed as a qualitative structured questionnaire. The study was composed of two stages. The personal health records of 2001 of Siauliai, Panevezys and Utena counties residents were analyzed and the cases of irrational drug use were selected, examined and verified during the first stage. There were 318 personal health records analyzed and 111 cases of irrational drug use verified. The 23 problems of irrational pharmacotherapy were distinguished and classified according to the responsibilities. The viewpoints of the physicians to the problems of the irrational pharmacotherapy were confirmed and analyzed during the second stage of the study. Thirty-one physicians were interviewed and responses summarized. CONCLUSIONS: 1. The irrational drug use took place in Siauliai, Panevezys and Utena counties of Lithuania in 2001. 2. Twenty-three types of problems of irrational pharmacotherapy can be distinguished. They can be classified into the 3 main levels according to the responsibility: the level of the administration (institution), the physician and the patient; other problems can be distinguished separately. 3. The most frequently specified by physicians possible reasons of the irrational drug use were the lack of information, the overcharge of the physician and the lack of the qualification. 4. The most frequently specified possible solutions of the irrational drug use by physicians were the growth of qualification, the establishment of the algorithms and the increase of the time spent per patient. 5. There was noticed particular tendency at the level of the physicians: physicians eliminated their responsibility at this level and related the problems with other levels--the levels of the administration (institution) and the patient.