Experience in Monitoring Gentamicin Therapy during Treatment of Serious Gram-Negative Sepsis
Experience in Monitoring Gentamicin Therapy during Treatment of Serious Gram-Negative Sepsis
复制标题
严重革兰氏阴性脓毒症治疗过程中庆大霉素治疗监测的经验
作者：
P. Noone;T. Parsons;J. Pattison;R. Slack;D. Garfield;K. Hughes
本文报告了我们在65例住院患者中68次严重革兰阴性脓毒症治疗期间监测庆大霉素治疗的经验。大多数患者有严重的基础疾病。在接受充分治疗的患者中（败血症、尿路感染和伤口感染的72小时内血清峰浓度≥ 5 μg/ml;肺炎治疗过程中的某个时间≥ 8 μg/ml），84%（55例中的46例）治愈。在所有成人患者中，仅通过以5 mg/kg/天的剂量方案开始，分三次给药，随后的剂量由快速血清测定结果确定，才能达到这些血清浓度。肾毒性和症状性耳毒性的发生率不高于先前系列。测定血清庆大霉素的主要原因是确保尽快达到足够的剂量。在肾功能受损或接受长期高剂量测定的患者中，也可用于防止庆大霉素过度蓄积和毒性风险增加。
This paper reports our experience in monitoring gentamicin therapy during the treatment of 68 episodes of serious Gram-negative sepsis in 65 hospital patients. Most of the patients had major underlying disease. Of those who were adequately treated (peak serum concentrations of 5 μg/ml or more in 72 hours for septicaemia, urinary tract infection, and wound infection; and 8 μg/ml or more at some time during the course of treatment for pneumonia) 84% (46 out of 55) were cured. These serum concentrations could be achieved only by starting with a regimen of 5 mg/kg/day in three divided doses in all adult patients, subsequent dosage being determined by the results of rapid serum assay. The incidence of nephrotoxicity and symptomatic ototoxicity was no greater than in previous series. The main reason for assaying serum gentamicin is to ensure that an adequate dosage is achieved as soon as possible. In patients with impaired renal function or receiving prolonged high dosage assays also serve to guard against an excessive accumulation of gentamicin and an increased risk of toxicity.