Noone P, Parsons T M, Pattison J R, Slack R C, Garfield-Davies D, Hughes K
Br Med J. 1974 Mar 16;1(5906):477-81. doi: 10.1136/bmj.1.5906.477.
This paper reports our experience in monitoring gentamicin therapy during the treatment of 68 episodes of serious Gram-negative sepsis in 65 hospital patients. Most of the patients had major underlying disease. Of those who were adequately treated (peak serum concentrations of 5 mug/ml or more in 72 hours for septicaemia, urinary tract infection, and wound infection; and 8 mug/ml or more at some time during the course of treatment for pneumonia) 84% (46 out of 55) were cured. These serum concentrations could be achieved only by starting with a regimen of 5 mg/kg/day in three divided doses in all adult patients, subsequent dosage being determined by the results of rapid serum assay. The incidence of nephrotoxicity and symptomatic ototoxicity was no greater than in previous series. The main reason for assaying serum gentamicin is to ensure that an adequate dosage is achieved as soon as possible. In patients with impaired renal function or receiving prolonged high dosage assays also serve to guard against an excessive accumulation of gentamicin and an increased risk of toxicity.
本文报告了我们对65例住院患者68次严重革兰氏阴性菌败血症治疗过程中监测庆大霉素治疗效果的经验。大多数患者有严重的基础疾病。在接受充分治疗的患者中（败血症、尿路感染和伤口感染患者在72小时内血清峰值浓度达到5微克/毫升或更高；肺炎患者在治疗过程中的某个时间点血清峰值浓度达到8微克/毫升或更高），84%（55例中的46例）治愈。所有成年患者均需起始剂量为5毫克/千克/天，分三次给药，随后根据快速血清检测结果确定后续剂量，才能达到上述血清浓度。肾毒性和症状性耳毒性的发生率并不高于以往系列报道。检测血清庆大霉素的主要目的是确保尽快达到足够的剂量。对于肾功能受损或接受长期高剂量治疗的患者，检测还可防止庆大霉素过度蓄积以及毒性风险增加。
