Graham A Christie, Mercier Renee-Claude, Achusim Louis E, Pai Manjunath P
School of Pharmacy, University of Wyoming, Laramie, WY, USA.
Ann Pharmacother. 2004 Jun;38(6):936-41. doi: 10.1345/aph.1D514. Epub 2004 Apr 14.
Gram-positive osteomyelitis requires long-term antibiotic therapy, much of which is often administered in the outpatient setting. Historically, synergistic aminoglycoside use in these infections requires multiple daily doses, which can be inconvenient. Data regarding extended-interval aminoglycoside dosing (EIAD), also known as once-daily dosing, in this setting are lacking.
To evaluate the safety and efficacy of EIAD in the treatment of gram-positive osteomyelitis.
Retrospective chart review of adult patients treated for documented, gram-positive osteomyelitis with EIAD at the University of New Mexico Home IV Antibiotic Clinic was conducted. The patients' medical records were reviewed by an infectious diseases clinical pharmacist. Clinical and microbiologic outcomes and the incidence of nephrotoxicity and ototoxicity were the main outcome measures.
Fifteen patients (16 events) were included. Enterococcus spp. was the most common organism isolated. Nine patients had infected equipment or devices; 6 of these had removal of these devices in conjunction with antibiotic therapy. The median duration of antibiotic therapy was 6 weeks (range 6-31). The median duration of aminoglycoside therapy was 28 days (range 6-43). Seven patients developed nephrotoxicity, 5 of whom received an aminoglycoside in combination with vancomycin. Male patients had a higher risk of developing nephrotoxicity compared with females (p = 0.04). The mean +/- SD duration of EIAD before the development of nephrotoxicity was 34 +/- 8 days. Clinical cure was achieved in 12 (75%) patients. Three patients achieved clinical cure without hardware removal.
Most of the patients with gram-positive osteomyelitis were successfully managed with EIAD. However, nephrotoxicity developed in a high proportion of patients and was likely related to prolonged aminoglycoside use.
革兰氏阳性菌骨髓炎需要长期抗生素治疗，其中大部分通常在门诊进行。从历史上看，在这些感染中使用协同氨基糖苷类药物需要每日多次给药，这可能不太方便。在这种情况下，关于延长给药间隔氨基糖苷类药物给药（EIAD），也称为每日一次给药的数据尚缺乏。
评估EIAD治疗革兰氏阳性菌骨髓炎的安全性和有效性。
对在新墨西哥大学家庭静脉抗生素诊所接受EIAD治疗确诊的革兰氏阳性菌骨髓炎的成年患者进行回顾性病历审查。传染病临床药剂师审查了患者的病历。临床和微生物学结果以及肾毒性和耳毒性的发生率是主要结局指标。
纳入15例患者（16例事件）。粪肠球菌是最常见的分离菌。9例患者有感染的设备；其中6例在抗生素治疗的同时移除了这些设备。抗生素治疗的中位持续时间为6周（范围6 - 31周）。氨基糖苷类药物治疗的中位持续时间为28天（范围6 - 43天）。7例患者出现肾毒性，其中5例接受了氨基糖苷类药物与万古霉素联合治疗。男性患者发生肾毒性的风险高于女性（p = 0.04）。发生肾毒性前EIAD的平均±标准差持续时间为34±8天。12例（75%）患者实现临床治愈。3例患者未移除硬件设备即实现临床治愈。
大多数革兰氏阳性菌骨髓炎患者通过EIAD成功治疗。然而，高比例患者出现肾毒性，这可能与氨基糖苷类药物使用时间延长有关。
