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Effect of Nutritional Status on the Clinical Efficacy of Once-daily Dosing Regimens of Amikacin Sulfate in Elderly Patients

Yoshihiko MATSUKI1), Miki YAJIMA1), Tetsuya TSUKAMOTO2), Tamaki WATANABE3) and Shigekazu WATANABE3)
1)Department of Pharmacy, Funabashi General Hospital, Ageo Medical Group, 2)Department of Internal Medicine, Funabashi General Hospital, Ageo Medical Group, 3)Practical Pharmacy of Pharmaceutical Sciences, Teikyo University

As a method of amikacin sulfate (AMK) administration to elderly patients once daily, a reduction in the dose/body weight (mg/kg) according to the renal function is recommended. However, the possibility that a reduced dose cannot exhibit adequate antibacterial activity has been shown. Therefore, we administered AMK once daily to elderly patients and evaluated factors affecting clinical effects.
The subjects consisted of 330 patients with bacterial pneumonia (age, ≥65 years) who were treated with AMK. They were classified into responder and non-responder groups, and the dose, somatometry values, general blood examination values, and blood biochemical examination values were compared between the two groups.
Significant differences between the two groups were observed in Alb, RBC, Hb, and body weight. AMK dose did not differ between the two groups. Regarding Alb, RBC, and Hb that showed a difference between the responder and non-responder groups, a difference was observed in patients with a Cpeak < 41 μg/mL but not in those with a Cpeak ≥ 41 μg/mL. The incidence of renal function impairment did not differ between the groups with a Cpeak < 41 μg/mL or ≥ 41 μg/mL but was significantly higher in the group with a trough ≥ 4 μg/mL.
AMK administration to elderly patients once daily requires administration planning with consideration of a Cpeak ≥ 41 μg/mL even when the dose is reduced according to Ccr. Adequate antibacterial activity may not be achieved in patients with a low Alb, TP, RBC, Hb, or body weight.

Key words:amikacin sulfate, once-daily dosing, elderly patients, undernutrition


Received: April 6, 2017
Accepted: September 19, 2017

33 (1):7─14,2018

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