Wade W E, McCall C Y
College of Pharmacy, University of Georgia, Athens 30602.
Hosp Formul. 1990 Oct;25(10):1092-4, 1096.
A DUE was conducted at this institution to determine the incidence of aminoglycoside-induced nephrotoxicity. The charts of all patients (113) who received an aminoglycoside during the first quarter of 1989 were reviewed. Information gathered included patient age, aminoglycoside used, loading and maintenance doses, serum peak and trough concentrations, changes in serum creatinine during aminoglycoside administration, and culture and sensitivity results. Physicians were inconsistent in prescribing loading doses, while all patients dosed by the pharmacy received an initial dose of 1.5 to 1.75 mg/kg of ideal body weight for gentamicin and tobramycin. Ninety percent of maintenance doses were calculated by the pharmacy. All patients had serum peak concentrations between 3 and 10 micrograms/ml, and only three patients had serum trough concentrations greater than 2 micrograms/ml. No patient demonstrated changes in serum creatinine suggestive of clinically apparent nephrotoxicity. This study suggests that with routine pharmacist intervention (via a pharmacist-managed dosing service), aminoglycosides can be prescribed with a low incidence of nephrotoxicity.
该机构进行了一项药物利用评价（DUE）以确定氨基糖苷类药物所致肾毒性的发生率。对1989年第一季度所有接受过氨基糖苷类药物治疗的患者（113例）的病历进行了回顾。收集的信息包括患者年龄、使用的氨基糖苷类药物、负荷剂量和维持剂量、血清峰浓度和谷浓度、氨基糖苷类药物给药期间血清肌酐的变化以及培养和药敏结果。医生在开具负荷剂量时并不一致，而所有由药房给药的患者接受的庆大霉素和妥布霉素初始剂量为理想体重的1.5至1.75mg/kg。90%的维持剂量由药房计算。所有患者的血清峰浓度在3至10μg/ml之间，只有3例患者的血清谷浓度大于2μg/ml。没有患者出现提示临床明显肾毒性的血清肌酐变化。这项研究表明，通过常规的药剂师干预（通过药剂师管理的给药服务），氨基糖苷类药物的肾毒性发生率较低。
