Dasta J F, Armstrong D K
Division of Pharmacy Practice, Ohio State University, College of Pharmacy, Columbus 43210.
Crit Care Med. 1988 Apr;16(4):327-30. doi: 10.1097/00003246-198804000-00004.
The pharmacokinetics of the aminoglycosides were evaluated in 181 patients admitted to a surgical ICU. Pharmacokinetic parameters changed from 16% to 40% during therapy requiring multiple dosage adjustments and nearly nine drug levels per patient. Dosage adjustments resulted in peak and trough serum concentrations within the therapeutic range 71% and 74% of the time. Aminoglycoside half-life (T1/2) ranged from 1.1 to 69.3 h. Aminoglycoside volume of distribution also varied considerably with an average value of 0.36 L/kg. During therapy most patients gained weight (average 8.4 kg) which correlated with their corresponding fluid gain of 11.6 L. Pharmacokinetic parameters were variable even in patients with a normal serum creatinine. Less than 50% of these patients received the recommended daily dosages. This study suggests that the aminoglycoside volume of distribution in critically ill surgical patients differs from general hospital patients and pharmacokinetic parameters change considerably during therapy. We recommend obtaining timed serum aminoglycoside concentrations early in therapy and adjusting drug dosages as needed to maintain serum concentrations in the therapeutic range.
在181名入住外科重症监护病房（ICU）的患者中评估了氨基糖苷类药物的药代动力学。在需要多次调整剂量且每位患者平均检测近9次血药浓度的治疗期间，药代动力学参数变化了16%至40%。剂量调整使71%的峰值和74%的谷值血清浓度处于治疗范围内。氨基糖苷类药物的半衰期（T1/2）为1.1至69.3小时。氨基糖苷类药物的分布容积也有很大差异，平均值为0.36L/kg。治疗期间，大多数患者体重增加（平均8.4kg），这与其相应的11.6L液体增加量相关。即使血清肌酐正常的患者，其药代动力学参数也存在差异。这些患者中不到50%接受了推荐的每日剂量。本研究表明，重症外科患者中氨基糖苷类药物的分布容积与综合医院患者不同，且治疗期间药代动力学参数变化很大。我们建议在治疗早期定时检测血清氨基糖苷类药物浓度，并根据需要调整药物剂量，以维持血清浓度在治疗范围内。
