Appropriateness of Amikacin Dose Prescription, Monitoring and Safety during Hospitalization as an Impact of Clinical Pharmacologist Intervention, in the Israeli Regional Hospital ()
Affiliation(s)
1Clinical Pharmacology Unit, Kaplan Medical Center, Rehovot, and Hebrew University Hadassah Medical School, Jerusalem, Israel.
2Department of Medicine, Kaplan Medical Center, Rehovot, and Hebrew University Hadassah Medical School, Jerusalem, Israel.
ABSTRACT
Background: Use of inappropriate amikacin dose is one of the most important
factors in inducing toxicity, prolonged hospitalization as well as in increasing
patient’s mortality. Objective: The aims of this study are the analysis
of amikacin dose, serum level and the examination of the effectiveness of the
clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention
to guarantee the safety of amikacin use. Methods: This is a one-year retrospective
observational chart review study, which evaluates amikacin dose,
serum drug level, development of adverse effects in patients on amikacin with
or without CP TDM consultation. Results: Amikacin was prescribed for 393
complex patients, with median age 83. Amikacin group (AG) included 140
(32%) courses with CP consultation (AG1) and 292 (68%) courses without
CP consultation (AG2). The distribution of most study characteristics in both
groups was similar including amikacin dose (9-10 mg/kg/day), renal failure
(14%) and mortality (12%). Acceptance for CP consultation was in 46% of
amikacin courses and dose changes were done in 63% after CP intervention.
Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the
patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent
in the AG1 compared to the AG2. There was a strong association between CP
consultation and prolonged hospitalization (p = 0.005), while no association
between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was
more in the management of complicated clinical situations. However, it is
necessary to optimize it.
Share and Cite:
Shihmanter, R. , Lazar, O. and Arcavi, L. (2024) Appropriateness of Amikacin Dose Prescription, Monitoring and Safety during Hospitalization as an Impact of Clinical Pharmacologist Intervention, in the Israeli Regional Hospital.
Journal of Biosciences and Medicines,
12, 337-354. doi:
10.4236/jbm.2024.123028.
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