Doso Saputro, Iswinarno (2009) RESEARCH MONITORING SERUM CONCENTRATION FOLLOWING ADMINISTRATION ONCE DAILY DOSING OF AMIKACIN IN BURN PATIENTS (STUDY IN BURN PATIENTS AT SOETOMO HOSPITAL, SURABAYA). Departemen Bedah Plastik Rekonstruksi dan estetik. pp. 1-12.

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Abstract

Controlling infection is important in burn patients management therapy. Amikacin is indicated for therapy of gram negative bacteria. Arnikacin shows pharmacokinetic alteration in burn patients. At Sutomo Hospital, bum patient receive once daily dosing (lx750mg i.v. bolus) of amikacin. On several studies observed that burn patients receiving amikaein IS mg/kg once daily often had inadequate therapeutic concentration, thus incresed amikacin dosage is required. The aim of the present study was to evaluate peak concentration (Cmaks) and through concentration (Cmin) related to therapeutic concentration, to evaluate extended-interval dosing, to determine factors affecting therapeutic concentration when using a once daily regimen of 750 mg amikacin. This research was approved by the local ethics committee. This study covered all severe bum patients, age of 15-70, receiving amikacin injection. Pregnancy, drug allergy, shock, and receiving other medicines which was able to influence measurement of amikacin concentration with Homogenoues Particle-Enhanced Turbidimetric Immunoassay" (PETIA) method, and/or to alter amikacin pharmacokinetic were excluded from this research. Twenty five patients were involved in this study. PETIA method was applied in monitoring amikacin serum concentration. Three serum concentration was drawn in one hour, in time range of 1-8 hours, and around 24 hours after amikacin injection. The results showed that targeted therapeutic concentration 64 μg/ml (Cmaks/MIC≥8 (MIC 8μg/ml)) was not achieved by all twenty five bum patients, therapeutic concentration 32 μg/ml (Cmaks/MIC 2≥8 (MIC 4 ug/ml) was reached by 3 patient (12%); 14 pasien (56%) achieved Cmaks/MIC ≥5 (MIC = 4 μg/ml); the rest 8 bum patient did not reached Cmaks/MIC≥5 (MIC 4μg/ml); all patients had Cmin below 2 ug/ml; and 24 hours interval dosing was inadequate. In burn, there were no covariates (burn size, prognostic and mortality score [Unit Burn Standard, Baux Index, Tobiasen Index, albumin, and renal function), that correlated with the altered of amikacin pharmacokinetic parameter, and that could be used to predict the changes in dosage required to attain therapeutic concentration. Based on amikacin phannacokinetic analysis in these patients, it suggested that 12 hours interval dosing was applied and monitoring amikacin serum concentration in each bum patient to determine individual amikacin dosage.

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