Netilmicin in Gram-Negative Sepsis

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Abstract
The preferred dose of netilmicin was determined in each of 39 patients with severe gram-negative sepsis treated at two centres. The dose was based upon the attainment of recommended serum concentrations. Patient age varied from 18 to 87 years (mean 58), estimated creatinine clearance from 20 to 150 ml/min (mean 71), and the preferred dose from 100 to 750 mg/24 h. The dose generated by a nomogram for netilmicin was compared in retrospect with the initial dose assigned to each patient by the clinical microbiologist concerned. With respect to the preferred dose, the nomogram underdosed, on the average, by 40 mg/24 h, and the microbiologists, by 30 mg/24 h. The correlation with the preferred dose was stronger for the nomogram dose (r = 0.66; p < 0.001), 37 df) than for the microbiologists'' dose (r = 0.47; p < 0.005, 37 df) but there was no significant difference between the two in the frequency with which they predicted the preferred dose to within 50 mg/24 h (nomogram 16/39; microbiologists 16/39). The prescription of a fixed dose of 450 mg/day to all patients would have had a similar success rate (15/39). The performance of the nomogram was better in patients with serum creatinine concentrations of .gtoreq. 100 .mu.M (r = 0.82; p < 0.001, 13 df; 10/15 within 50 mg/24 h of preferred dose) than in those with creatinine concentrations < 100 .mu.M (r = 0.55; p < 0.01, 22 df; 9/24 within 50 mg/24 h of preferred dose).

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