Impact of a high loading dose of amikacin in patients with severe sepsis or septic shock

• Published in: Annals of intensive care 2016-12, Vol.6 (1), p.106-8, Article 106
• Main Authors: Allou, Nicolas, Bouteau, Astrid, Allyn, Jérôme, Snauwaert, Aurélie, Valance, Dorothée, Jabot, Julien, Bouchet, Bruno, Galliot, Richard, Corradi, Laure, Montravers, Philippe, Augustin, Pascal
• Format: Article
• Language: English
• Subjects: Anesthesiology; Critical Care Medicine; Emergency Medicine; Intensive; Intensive care; Medicine; Medicine & Public Health
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-016-0211-z

Background The therapeutic effect of aminoglycosides is highest and optimal when the peak plasma concentration ( C max )/minimal inhibitory concentration (MIC) ratio is between 8 and 10. The French guidelines recommend to use high doses of aminoglycosides for empiric antibiotic therapy in patients suffering from severe sepsis or septic shock. In clinical practice, the recommended target is an amikacin C max between 60 and 80 mg/L, which corresponds to approximately 8 times the MIC breakpoint, as defined by the European Committee on Antimicrobial Susceptibility Testing. The aim of this study was to assess the incidence and impact on mortality of an amikacin concentration between 60 and 80 mg/L in patients suffering from severe sepsis or septic shock. Methods This was a prospective observational cohort study conducted in two intensive care units (ICU). Patients receiving amikacin at a loading dose of 30 mg/kg for severe sepsis or septic shock were enrolled in the cohort. The target C max for amikacin was between 60 and 80 mg/L, as recommended by French guidelines (i.e. C max /MIC breakpoint = 8–10). Results Over the study period, the amikacin C max was 80 mg/L in 20 (18.2%), 46 (41.8%) and 44 (40%) of the 110 selected patients, respectively. Mortality rate was 40, 28.3 and 56.8% in the groups of patients with C max