Fayed D F, Dahmash N S, al-Zeer A H, Shibl A M, Huraib S O, Abu-Aisha H
Department of Clinical Pharmacy, King Khalid University Hospital (KKUH) and College of Medicine, Riyadh, Saudi Arabia.
J Chemother. 1996 Dec;8(6):457-64. doi: 10.1179/joc.1996.8.6.457.
Forty critically ill adult patients with severe Gram-negative infection were treated with once-daily amikacin combined with ceftazidime. The mean age was 56.6 +/- 19 years and mean APACHE II score was 22.7 +/- 6.6. Forty percent of patients required mechanical ventilation. The mean creatinine clearance at onset of therapy was 59.4 +/- 28 ml/min. All bacterial isolates were sensitive to amikacin. Fixed doses of amikacin 15 mg/kg, 12 mg/kg, and 8 mg/kg body weight were given once daily to patients with estimated creatinine clearance of > 80 ml/min., 50-80 ml/min., and < 50 ml/min, respectively. Forty-two causative gram-negative bacteria were isolated from 40 patients. The most common bacteria were Pseudomonas aeruginosa (18), and Escherichia coli (10). Overall clinical success and bacteriological eradication occurred in 85% and 87.5% of patients; 78.9% and 79% of patients with hospital-acquired infections; 90.5% and 95.2% of patients with community-acquired infections; and 62.5% and 81.3% of patients requiring mechanical ventilation, respectively. Therapeutic failure was documented in 15% of patients. Death due to infection was scored in two patients. The remaining were all due to persistence of the initial causative bacteria in patients with hospital-acquired infections. Persistence was documented with Ps. aeruginosa (2), Serratia spp. (1), and Acinetobacter spp. (1). Overall mortality occurred in 22.5% patients. Death unrelated to infection occurred in 7 patients. There was no clinical evidence of ototoxicity in any of our patients, however, nephrotoxicity was documented in 5%. In conclusion, once-daily amikacin combined with ceftazidime is practical, efficacious and probably safe in critically ill infected patients.
40例患有严重革兰阴性菌感染的成年危重症患者接受了每日一次的阿米卡星联合头孢他啶治疗。平均年龄为56.6±19岁，平均急性生理学与慢性健康状况评分系统II（APACHE II）评分为22.7±6.6。40%的患者需要机械通气。治疗开始时的平均肌酐清除率为59.4±28 ml/分钟。所有分离出的细菌对阿米卡星均敏感。对于估计肌酐清除率>80 ml/分钟、50 - 80 ml/分钟和<50 ml/分钟的患者，分别每日一次给予固定剂量的阿米卡星，剂量为15 mg/kg、12 mg/kg和8 mg/kg体重。从40例患者中分离出42株致病性革兰阴性菌。最常见的细菌是铜绿假单胞菌（18株）和大肠杆菌（10株）。总体临床成功率和细菌清除率分别为85%和87.5%；医院获得性感染患者中分别为78.9%和79%；社区获得性感染患者中分别为90.5%和95.2%；需要机械通气的患者中分别为62.5%和81.3%。15%的患者记录有治疗失败。两名患者因感染死亡。其余均是由于医院获得性感染患者中初始致病细菌持续存在所致。持续性感染记录于铜绿假单胞菌（2例）、沙雷菌属（1例）和不动杆菌属（1例）。总体死亡率为22.5%。7例患者死于与感染无关的原因。我们的任何患者均无耳毒性的临床证据，然而，5%的患者记录有肾毒性。总之，每日一次的阿米卡星联合头孢他啶在危重症感染患者中实用、有效且可能安全。
