Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department.
<h4>Objective</h4>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...
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2019-01-01
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doaj-149d549749004410b59c17263d80a51b2021-03-04T10:37:21ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01141e021001210.1371/journal.pone.0210012Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department.Maarten CobussenPatricia M StassenDirk PosthouwerFrank H van TielPaul H M SavelkoulThomas HavenithMichiel B Haeseker<h4>Objective</h4>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.<h4>Methods</h4>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) × 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.<h4>Results</h4>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.<h4>Conclusion</h4>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.https://doi.org/10.1371/journal.pone.0210012 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Maarten Cobussen Patricia M Stassen Dirk Posthouwer Frank H van Tiel Paul H M Savelkoul Thomas Havenith Michiel B Haeseker |
spellingShingle |
Maarten Cobussen Patricia M Stassen Dirk Posthouwer Frank H van Tiel Paul H M Savelkoul Thomas Havenith Michiel B Haeseker Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department. PLoS ONE |
author_facet |
Maarten Cobussen Patricia M Stassen Dirk Posthouwer Frank H van Tiel Paul H M Savelkoul Thomas Havenith Michiel B Haeseker |
author_sort |
Maarten Cobussen |
title |
Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department. |
title_short |
Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department. |
title_full |
Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department. |
title_fullStr |
Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department. |
title_full_unstemmed |
Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department. |
title_sort |
improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2019-01-01 |
description |
<h4>Objective</h4>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.<h4>Methods</h4>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) × 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.<h4>Results</h4>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.<h4>Conclusion</h4>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. |
url |
https://doi.org/10.1371/journal.pone.0210012 |
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