AMINOGLYCOSIDE LEVELS IN CRITICALLY ILL SURGICAL PATIENTS - THE IMPLICATIONS OF PHYSIOLOGICAL CRITERIA OF SEPSIS

We retrospectively reviewed medical records and computerized critical care data for 40 consecutive critically ill surgical patients receivin g ''standard'' doses (1.5 to 2.0 mg/kg loading dose and 3 to 5 mg/kg/d ay) of gentamicin or tobramycin for gram-negative infections, End poin ts measured were serum drug levels and clearance of infection, Therape utic serum aminoglycoside levels were achieved within 48 hours of ther apy by only 7 patients (17.5%), Among the remaining 33 patients, signi ficantly fewer septic than nonseptic patients had clearance of their i nfection (11% vs 92%). Specific physiologic criteria of sepsis may be used to identify critically ill patients who will most likely benefit from aggressive initial aminoglycoside dosing when these drugs are use d to treat gram-negative infections.