Sugiyama Kyohei, Hirai Keita, Suyama Yukako, Tsutsumi Masato
Department of Pharmacy, Shizuoka General Hospital, 4-27-1 Kita Ando Aoi-ku, Shizuoka, 420- 8527, Japan.
Department of Clinical Pharmacology and Therapeutics, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
J Pharm Health Care Sci. 2024 Jul 15;10(1):40. doi: 10.1186/s40780-024-00360-y.
Gentamicin is a commonly used antibiotic with synergistic effects that is administered once or multiple times daily. However, the influence of the daily administration frequency on renal function has not yet been identified. This study aimed to investigate the effect of the daily dosing frequency on worsening renal function in patients receiving gentamicin.
This study included 35 patients undergoing gentamicin treatment who had at least one serum trough level measured and underwent therapeutic drug monitoring (TDM). We evaluated the influence of daily dosing frequency on gentamicin trough concentration and the risk of acute kidney injury (AKI).
Compared to patients who received gentamicin once-daily dosing (n = 22), patients who received multiple-daily dosing (n = 13) had significantly higher initial and minimum trough concentrations after TDM. The proportion of patients with trough concentrations lower than 1.0 µg/mL was significantly higher in the once-daily dosing group at the initial trough concentration, whereas there was no significant difference at the minimum trough concentration after TDM. AKI developed in nine patients; however, there was no significant difference in the incidence of AKI according to the frequency of daily gentamicin dosing. In contrast, a higher minimum trough concentration after TDM was found to be a risk factor for AKI development with an odds ratio of 9.2 (95% confidence intervals; 1.3-65.5).
A higher trough concentration of gentamicin correlated with a higher incidence of AKI. The risk of developing AKI may be reduced by choosing a once-daily dosing regimen or implementing TDM.
庆大霉素是一种常用的具有协同作用的抗生素，每日给药一次或多次。然而，每日给药频率对肾功能的影响尚未明确。本研究旨在探讨每日给药频率对接受庆大霉素治疗患者肾功能恶化的影响。
本研究纳入了35例接受庆大霉素治疗且至少测量过一次血清谷浓度并接受治疗药物监测（TDM）的患者。我们评估了每日给药频率对庆大霉素谷浓度的影响以及急性肾损伤（AKI）的风险。
与每日一次给药的患者（n = 22）相比，每日多次给药的患者（n = 13）在TDM后的初始和最低谷浓度显著更高。在初始谷浓度时，每日一次给药组谷浓度低于1.0 μg/mL的患者比例显著更高，而在TDM后的最低谷浓度时无显著差异。9例患者发生了AKI；然而，根据庆大霉素每日给药频率，AKI的发生率没有显著差异。相比之下，TDM后较高的最低谷浓度被发现是AKI发生的一个危险因素，比值比为9.2（95%置信区间：1.3 - 65.5）。
庆大霉素较高的谷浓度与AKI的较高发生率相关。通过选择每日一次给药方案或实施TDM，可能会降低发生AKI的风险。
