INCREASED BURN PATIENT SURVIVAL WITH INDIVIDUALIZED DOSAGES OF GENTAMICIN

  • 1 January 1982
    • journal article
    • research article
    • Vol. 91  (2) , 142-149
Abstract
The clinical effect of measuring serum gentamicin concentrations and individualizing each patient''s dosage regimen was determined in 105 burn patients with severe gram-negative sepsis. Patients [39] (conventionally dosed group) received the recommended dosage regimen of 3-5 mg/kg per day from 1972-1974. From 1974-1976, serum concentrations were measured in 66 patients (individually dosed group), and each patient''s dose was individually calculated to obtain therapeutic serum concentrations. All patients had normal renal function prior to initiation of gentamicin therapy. For each group, 16 independent variables were compared that may have influenced treatment response. The patients in the individually dosed group required an average dose of 7.4 mg/kg per day to achieve therapeutic concentrations, compared to the average dose of 4.4 mg/kg per day for the patients receiving conventional doses (P < 0.001). An abrupt increase in patient survival occurred with the implementation of individualized regimens. Patient survival rates for the entire hospital course were 33 and 64% for the conventionally dosed and individually dosed groups, respectively (P < 0.005). Survival rates for the first septic episode were 51.3 and 86.4%, respectively (P < 0.001). Individualized gentamicin regimens, age, percent burn and sex were the statistically significant variables related to patient survival for the 1st episode of sepsis. Age, percent burn, individualized dosing, complications during hospitalization and a positive blood culture were significant factors related to patient survival for the entire hospital course. These data confirm the need for measuring serum gentamicin concentrations and adjusting dosages to ensure therapeutic levels and maximal efficacy of gentamicin in burn patients.