Dahlgren J G, Anderson E T, Hewitt W L
Antimicrob Agents Chemother. 1975 Jul;8(1):58-62. doi: 10.1128/AAC.8.1.58.
Gentamicin blood levels were monitored in 86 patients. Twenty-one patients had valley levels over 2 mug/ml and 36% of these patients developed abnormal serum creatinine or a further rise in creatinine. No patient had a rise in creatinine without a valley level over 2. The peak levels in patients with valleys over 2 were above 10 mug/ml in only one case, whereas four patients had peaks over 10 mug/ml without nephrotoxicity. The mean peak blood levels in patients with a normal creatinine were dose related. An initial dose of 2.0, 1.5, and 1.3 or less mpk (mg/kg) yielded mean peak blood levels of 5.2, 4.7, and 3.7, respectively. To assure an initial peak blood level over 4 mug/ml a loading dose of 2 mpk was required. A rise in peak and valley levels during therapy appeared dose related, being observed in all patients treated with 4.5 mpk daily but not in those receiving 3.0 mpk daily. A radioenzymatic assay was used to validate the standard agar diffusion assay method. The results from the two assays were statistically identical. Valley blood levels of gentamicin may be useful for predicting accumulation of gentamicin which in turn may be correlated with early renal impairment before potentially toxic serum levels of gentamicin develop.
对86例患者的庆大霉素血药浓度进行了监测。21例患者的谷浓度超过2微克/毫升，其中36%的患者出现血清肌酐异常或肌酐进一步升高。没有患者在谷浓度未超过2的情况下出现肌酐升高。谷浓度超过2的患者中，仅1例峰值浓度超过10微克/毫升，而4例峰值浓度超过10微克/毫升的患者未出现肾毒性。肌酐正常的患者平均峰值血药浓度与剂量相关。初始剂量为2.0、1.5和1.3毫克/千克或更低时，平均峰值血药浓度分别为5.2、4.7和3.7。为确保初始峰值血药浓度超过4微克/毫升，需要2毫克/千克的负荷剂量。治疗期间峰值和谷浓度的升高似乎与剂量相关，在每日接受4.5毫克/千克治疗的所有患者中均有观察到，但在每日接受3.0毫克/千克治疗的患者中未观察到。采用放射酶法验证标准琼脂扩散法。两种检测方法的结果在统计学上是相同的。庆大霉素的谷血药浓度可能有助于预测庆大霉素的蓄积，而庆大霉素的蓄积又可能与庆大霉素潜在毒性血清水平出现之前的早期肾功能损害相关。
