ADAPTIVE-CONTROL OF AMIKACIN THERAPY IN T HE ELDERLY - A RETROSPECTIVE ANALYSIS OF EFFICACY AND TOXICITY

The authors previously showed the precision of adaptive control of ami kacin therapy in elderly patients. The present retrospective study eva luated the effects of such therapy on outcomes. 48 patients, aged 80 /- 5 years, with estimated creatinine clearance (eCCR) of 48 +/- 15 ml /mn, received amikacin initial dosage of 13,3 +/- 3,5mg//kg/d, alone o r with other drugs. Efficacy outcomes were : E1 = changes in dosage du ring therapy; E2 = fever reduction within 3 days after therapy; E3 = e radication of infection by culture data; E4 = reduction of white blood cell count (WCB) to normal; E5 = overall recovery. Toxicity outcomes were : T1 = subjective ototoxicity ; T2 = nephrotoxicity, variation of serum creatinine low (between 18 et 44 mu mol/l) or high (over 0,5 mg /dl). Results : E1 : final dose = 11,8 +/- 5,1 mg/kg/d (NS), 57 % redu ced, 33 % increased, during 15,1 +/- 9,3 days in therapy, with 88 % ha ving effective peaks over 15 mu g/ml. E2 : fever reduced within 3 days 16/37; after 12/37; no change, 9/37. E3 : cultures became negative, 1 3/28. E4 : WBC fell early, 10/21; late, 7/21; no change, 2/21. E5 : re covery 36; death, 8; change in therapy, 3. T1 : no clinical signs of o totoxicity. T2 : low(+), 9/51; low(-), 11/51; hight(-), 7/51. final eC CR: 48 +/- 14 ml/mn (NS); no nephrotoxicity. These results suggest tha t adaptive control of amikacine regimens yields good efficacy and avoi d toxicity in the Elderly. However, prospective controlled clinical tr ials should be done for confirmation.