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Determinants of amikacin first peak concentration in critically ill patients

Abstract : Amikacin antimicrobial effect has been correlated with the ratio of the peak concentration (Cmax ) to the minimum inhibitory concentration. A target Cmax >= 60-80 mg/L has been suggested. It has been shown that such target is not achieved in a large proportion of critically ill patients in intensive care units. A retrospective analysis was performed to examine the determinants of Cmax >= 80 mg/L on the first peak in 339 critically ill patients treated by amikacin. The influence of available variables on Cmax target attainment was analyzed using a classification and regression tree (CART) and logistic regression. Mean Cmax in the 339 patients was 73.0 \textpm 23.9 mg/L, with a target attainment rate (TAR, Cmax >= 80 mg/L) of 37.5%. In CART analysis, the strongest predictor of amikacin target peak attainment was dose per kilogram of lean body weight (dose/LBW). TAR was 60.1% in patients with dose/LBW >= 37.8 vs. 19.9% in patients with lower dose/LBW (OR = 6.0 (95% CI: 3.6-10.2)). Renal function was a secondary predictor of Cmax . Logistic regression analysis identified dose per kilogram of ideal body weight (OR = 1.13 (95% CI: 1.09-1.17)) and creatinine clearance (OR = 0.993 (95% CI: 0.988-0.998)) as predictors of target peak achievement. Based on our results, an amikacin dose >= 37.8 mg/kg of LBW should be used to optimize the attainment of Cmax >= 80 mg/L after the first dose in critically ill patients. An even higher dose may be necessary in patients with normal renal function.
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https://hal.archives-ouvertes.fr/hal-01953651
Contributor : Laure-Hélène Davoine <>
Submitted on : Thursday, December 13, 2018 - 11:00:44 AM
Last modification on : Tuesday, July 20, 2021 - 5:20:04 PM

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Clément Boidin, Sophie Jenck, Laurent Bourguignon, Sejad Torkmani, Aurore Roussey-Jean, et al.. Determinants of amikacin first peak concentration in critically ill patients. Fundamental and Clinical Pharmacology, Wiley, 2018, ⟨10.1111/fcp.12374⟩. ⟨hal-01953651⟩

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