Abstract
The pharmacokinetic parameters of gentamicin and tobramycin were evaluated and compared for 260 patients with pleural effusions and 1,049 patients without pleural effusions by chest radiograph. Pharmacokinetic data were collected prospectively and analyzed by using our aminoglycoside data base. Univariate analysis revealed that the patients with pleural effusions demonstrated significantly lower serum albumin concentrations, greater aminoglycoside volumes of distribution, longer elimination half-lives, and lower peak and higher trough concentrations in serum than the patients without pleural effusions. Patients with pleural effusions were significantly older and had lower total body weight. Stepwise multiple linear regression analysis revealed that lower total body weight and serum albumin concentration, presence of pleural effusion, and greater age were associated with significantly greater volumes of distribution. Calculated creatinine clearance, age, total body weight, and shock were associated with reduced aminoglycoside clearance in these patients.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Barza M., Lauermann M. Why monitor serum levels of gentamicin? Clin Pharmacokinet. 1978 May-Jun;3(3):202–215. doi: 10.2165/00003088-197803030-00002. [DOI] [PubMed] [Google Scholar]
- Bertino J. S., Jr, Booker L. A., Franck P., Rybicki B. Gentamicin pharmacokinetics in patients with malignancies. Antimicrob Agents Chemother. 1991 Jul;35(7):1501–1503. doi: 10.1128/aac.35.7.1501. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Carr M. R., Dick S. P., Bordley J., 4th, Bertino J. S., Jr Gentamicin dosing requirements in patients with acute pancreatitis. Surgery. 1988 May;103(5):533–537. [PubMed] [Google Scholar]
- Cockcroft D. W., Gault M. H. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41. doi: 10.1159/000180580. [DOI] [PubMed] [Google Scholar]
- Edson R. S., Terrell C. L. The aminoglycosides: streptomycin, kanamycin, gentamicin, tobramycin, amikacin, netilmicin, and sisomicin. Mayo Clin Proc. 1987 Oct;62(10):916–920. doi: 10.1016/s0025-6196(12)65048-4. [DOI] [PubMed] [Google Scholar]
- Gill M. A., Kern J. W. Altered gentamicin distribution in ascitic patients. Am J Hosp Pharm. 1979 Dec;36(12):1704–1706. [PubMed] [Google Scholar]
- Higuchi K., Kajiki A., Takamoto M., Ishibashi T. [Clinical trial of netilmicin in infections of respiratory organs and studies on its penetration into pleural fluid II. (author's transl)]. Jpn J Antibiot. 1982 Feb;35(2):667–674. [PubMed] [Google Scholar]
- Kiss J. I., Faragó E., Kónya L., Fábián E., Móricz F. Clinico-pharmacological examination of gentamycin in thoracic surgery. Int J Clin Pharmacol Biopharm. 1975 Oct;12(3):372–380. [PubMed] [Google Scholar]
- Lamy P. P. Comparative pharmacokinetic changes and drug therapy in an older population. J Am Geriatr Soc. 1982 Nov;30(11 Suppl):S11–S19. doi: 10.1111/j.1532-5415.1982.tb01351.x. [DOI] [PubMed] [Google Scholar]
- Levy J., Smith A. L., Koup J. R., Williams-Warren J., Ramsey B. Disposition of tobramycin in patients with cystic fibrosis: a prospective controlled study. J Pediatr. 1984 Jul;105(1):117–124. doi: 10.1016/s0022-3476(84)80375-3. [DOI] [PubMed] [Google Scholar]
- Levy R. H., Bauer L. A. Basic pharmacokinetics. Ther Drug Monit. 1986;8(1):47–58. doi: 10.1097/00007691-198603000-00010. [DOI] [PubMed] [Google Scholar]
- Moore R. D., Lietman P. S., Smith C. R. Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimal inhibitory concentration. J Infect Dis. 1987 Jan;155(1):93–99. doi: 10.1093/infdis/155.1.93. [DOI] [PubMed] [Google Scholar]
- Niemiec P. W., Jr, Allo M. D., Miller C. F. Effect of altered volume of distribution on aminoglycoside levels in patients in surgical intensive care. Arch Surg. 1987 Feb;122(2):207–212. doi: 10.1001/archsurg.1987.01400140089012. [DOI] [PubMed] [Google Scholar]
- Noone P., Parsons T. M., Pattison J. R., Slack R. C., Garfield-Davies D., Hughes K. Experience in monitoring gentamicin therapy during treatment of serious gram-negative sepsis. Br Med J. 1974 Mar 16;1(5906):477–481. doi: 10.1136/bmj.1.5906.477. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pechere J. C., Dugal R. Clinical pharmacokinetics of aminoglycoside antibiotics. Clin Pharmacokinet. 1979 May-Jun;4(3):170–199. doi: 10.2165/00003088-197904030-00002. [DOI] [PubMed] [Google Scholar]
- Sawchuk R. J., Zaske D. E. Pharmacokinetics of dosing regimens which utilize multiple intravenous infusions: gentamicin in burn patients. J Pharmacokinet Biopharm. 1976 Apr;4(2):183–195. doi: 10.1007/BF01086153. [DOI] [PubMed] [Google Scholar]
- Sketris I., Lesar T., Zaske D. E., Cipolle R. J. Effect of obesity on gentamicin pharmacokinetics. J Clin Pharmacol. 1981 Jul;21(7):288–293. doi: 10.1002/j.1552-4604.1981.tb01769.x. [DOI] [PubMed] [Google Scholar]
- Zarowitz B. J., Pilla A. M., Popovich J., Jr Expanded gentamicin volume of distribution in patients with indicators of malnutrition. Clin Pharm. 1990 Jan;9(1):40–44. [PubMed] [Google Scholar]
- Zaske D. E., Cipolle R. J., Strate R. G., Dickes W. F. Increased gentamicin dosage requirements: rapid elimination in 249 gynecology patients. Am J Obstet Gynecol. 1981 Apr 15;139(8):896–900. doi: 10.1016/0002-9378(81)90954-6. [DOI] [PubMed] [Google Scholar]
- Zaske D. E., Sawchuk R. J., Gerding D. N., Strate R. G. Increased dosage requirements of gentamicin in burn patients. J Trauma. 1976 Oct;16(10):824–828. doi: 10.1097/00005373-197610000-00014. [DOI] [PubMed] [Google Scholar]