CLINICAL OUTCOME AND ECONOMIC-IMPACT OF AMINOGLYCOSIDE PEAK CONCENTRATIONS IN FEBRILE IMMUNOCOMPROMISED PATIENTS WITH HEMATOLOGIC MALIGNANCIES

The aim of this study was to investigate the clinical and economic sig nificance of aminoglycoside peak concentrations in febrile neutropenic patients with hematologic malignancies. Sixty-one patients were treat ed according to protocol II of the Paul-Ehrlich-Gesellschaft: initial application of gentamicin or tobramycin in combination with a cephalos porin or ureidopenicillin and, after 3 days, a potential change of ant ibiosis to be decided in case of nonresponse. At the same time, sample s were collected by an independent controller. We found a significant dependence of clinical outcome on aminoglycoside peak concentrations ( P = 0.004). Twelve of 17 patients with peak concentrations >4.8 mg/L, but only 13 of 44 patients with concentrations less than or equal to 4 .8 mg/L, responded to initial therapy. Average infection-related costs per patient with peak values >4.8 mg/L were US$1429, $1790, and $1701 for nursing, diagnostics, and therapeutics, respectively (total $4920 ). Expenses for patients with peak concentrations less than or equal t o 4.8 mg/L were similar to 1.8-fold higher (average total $8.718). If all 61 patients had achieved peaks >4.8 mg/L, the potential savings wo uld have totalled $167 112. We conclude that neutropenic patients form a target group for successful pharmacokinetic intervention and cost s aving.