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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Bourguignon, Laurent Goutelle, Sylvain De Saint-Martin, Julie Burdin Maire, Pascal Ducher, Michel |
| Description | Country affiliation: France Author Affiliation: Bourguignon L ( Université de Lyon, F-69000, Lyon, France.) |
| Abstract | The aim of this simulation study was to evaluate the ability of three regimens proposed in official French recommendations for gentamicin to hit defined pharmacokinetic (PK) and pharmacodynamic targets in a population of elderly patients. The first drug regimen tested consisted of a loading dose of 1 mg/kg and a maintenance dose weighted by creatininemia, every 8 h. The second regimen consisted of a fixed dose of 1 mg/kg at various intervals of time, calculated from creatinine clearance. The last regimen was a fixed dose of 3 mg/kg once a day. All regimens were for 5 days. We used a bicompartmental PK model and implemented a Monte Carlo simulation to generate a large sample of geriatric subjects. The analysis examined three ranges of creatinine clearance. Simulations showed that for the two regimens using multiple doses per day, neither was able to reach an efficacy level without significant toxicity after 5 days of treatment, regardless of the level of renal function. The use of creatininemia or creatinine clearance to adjust the drug dose did not alter these findings. The once-a-day dosing regimen gave better results both in efficacy and toxicity, except for patients with creatinine clearance lower than 60 mL/min, where the incidence of potential toxicity was above 25%. These results strongly suggest that official French recommendations about aminoglycoside dosage regimens in elderly patients with renal impairment should be updated, and that the frequent need for therapeutic drug monitoring and dosage individualization should be clearly stated. |
| File Format | HTM / HTML |
| ISSN | 07673981 |
| Issue Number | 1 |
| Volume Number | 24 |
| e-ISSN | 14728206 |
| Journal | Fundamental & Clinical Pharmacology |
| Language | English |
| Publisher | Wiley |
| Publisher Date | 2010-02-01 |
| Publisher Place | Great Britain (UK) |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Pharmacology Anti-bacterial Agents Administration & Dosage Gentamicins Models, Biological Aged Aged, 80 And Over Pharmacokinetics Pharmacology Computer Simulation Creatinine Blood Urine Dose-response Relationship, Drug Drug Administration Schedule Humans Kidney Function Tests Monte Carlo Method Practice Guidelines As Topic Renal Insufficiency Complications Time Factors Comparative Study Journal Article |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pharmacology Pharmacology (medical) |
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