Japanese Society for Infection Prevention and Control-Online Journal

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Regression Analysis of the Relationship between Probability of Renal Function Impairment and Serum Trough Concentration of Amikacin

Yoshihiko MATSUKI¹⁾, Ken-ichi SAKO²⁾, Miki YAJIMA³⁾, Yoshikazu MATSUDA²⁾, Tamaki WATANABE⁴⁾⁵⁾ and Shigekazu WATANABE⁶⁾
¹⁾Department of Pharmacy, Kashiwa Kousei General Hospital, Ageo Medical Group, ²⁾Department of Clinical Pharmacy, Nihon Pharmaceutical University, ³⁾Department of Pharmacy, Funabashi General Hospital, ⁴⁾Hospital Pharmacy of Pharmaceutical Sciences, Teikyo University, ⁵⁾Department of Pharmacy, Teikyo University Hospital, ⁶⁾Research Center for the Promotion of Pharmacy and Pharmaceutical Practice of Pharmaceutical Sciences, Teikyo University

The antimicrobial activity of amikacin sulfate (AMK), an aminoglycoside antibiotic, is maximized when its maximum serum concentration (peak concentration) is maintained above a certain threshold. This concentration should be monitored carefully in patients with an impaired renal function as the degree of renal impairment increases with the minimum serum concentration (trough concentration). Thus, there is a need for a measure to minimize the risk of renal impairment in patients for whom an adjustment of administration intervals alone is not sufficient to select the optimal method of administration. To determine the appropriate use of AMK, we examined whether the trough concentration, which is known to be strongly associated with renal impairment, is associated with the risk of developing renal impairment. We examined data collected from 235 patients who were treated with AMK for infections, including bacterial pneumonia and urinary tract infection. We performed classification and regression tree analysis and selected a threshold of 2.55 and 6.85 μg/mL as the trough concentration. We also included 4.0 μg/mL, which is the reference value according to the Therapeutic Drug Monitoring Guidelines for Antimicrobials, to perform logistic regression analysis. The probabilities of developing renal impairment (mean (95% CI) ) were 2.7% (1.2-5.9), 3.6% (1.8-7.1), and 6.0% (3.3-10.8) at trough concentrations of 2.55, 4.0, and 6.85 μg/mL, respectively. Our findings suggest that instead of using a common cut-off value, the trough concentration should be determined on a per patient basis according to the risk of developing renal impairment when considering the administration of AMK.

Key words：amikacin sulfate, TDM, renal impairment

e-mail: cds306＠crest.ocn.ne.jp

Received: May 22, 2019
Accepted: October 8, 2019

35 (1)：22─30,2020