Blaser J, Simmen H P, Gonzenbach H R, Sonnabend W, Lüthy R
Ther Drug Monit. 1985;7(3):303-7.
Recommendations for optimal therapeutic peak concentrations of aminoglycosides are often not differentiated with respect to duration of infusion and timing of peak sample thereafter. To document the relevance of the timing, 139 dose intervals were analyzed in 58 patients during administration of gentamicin, amikacin, and netilmicin. Serum concentrations measured immediately after 30-min infusions were compared with concentrations obtained 90 min later (2 h values). The ratio of 30 min/2 h concentrations showed considerable variability. This ratio was less than 1.5 in 15% of the dose intervals analyzed and greater than 3 in 8% of the intervals. The poor correlation between concentrations measured at 30 min and at 2 h was documented by the coefficients of variation of 0.82, 0.30, and 0.67 for gentamicin, amikacin, and netilmicin, respectively. This variability was not explained by interindividual differences, renal function, or drug half-life. However, the initial decrease in concentrations was significantly lower in patients with impaired renal function (p less than 0.001). These data suggest that timing is critical for the sampling of serum to determine peak levels in patients and the definition of optimal therapeutic concentrations.
关于氨基糖苷类药物最佳治疗峰值浓度的建议，在输注持续时间及随后峰值样本采集时间方面通常未作区分。为证明采集时间的相关性，在58例使用庆大霉素、阿米卡星和奈替米星的患者中分析了139个给药间隔。将30分钟输注结束后立即测得的血清浓度与90分钟后（2小时值）测得的浓度进行比较。30分钟/2小时浓度之比显示出相当大的变异性。在所分析的给药间隔中，该比值在15%的间隔中小于1.5，在8%的间隔中大于3。庆大霉素、阿米卡星和奈替米星在30分钟和2小时测得的浓度之间的相关性较差，其变异系数分别为0.82、0.30和0.67。这种变异性无法用个体差异、肾功能或药物半衰期来解释。然而，肾功能受损患者的浓度初始下降明显更低（p<0.001）。这些数据表明，采集血清样本以确定患者峰值水平及定义最佳治疗浓度时，采集时间至关重要。
