Individualized pharmacokinetic monitoring results in less aminoglycoside-associated nephrotoxicity and fewer associated costs

Study Objective. To examine the impact of individualized pharmacokinetic mo nitoring (IPM) on the development of aminoglycoside-associated nephrotoxici ty (AAN). Design. Retrospective case-control study. Setting. Two teaching hospitals. Subjects. Two thousand four hundred five patients who received aminoglycosi des. Intervention. Aminoglycoside therapy dosed by either IPM or physicians' dir ections. Measurements and Main Results. Patients receiving IPM were significantly le ss likely to develop AAN by both univariate (7.9% vs 13.2%, p=0.02) and mul tivariate methods (odds ratio 0.42, p=0.002). Female sex was protective aga inst AAN. Age 50 years and above, high initial aminoglycoside trough, long duration of therapy, and concurrent piperacillin, clindamycin, or vancomyci n increased risk of AAN. We estimated that IPM decreased AAN costs by $90,9 93/100 patients. Conclusion. Individualized pharmacokinetic monitoring significantly decreas ed the frequency of AAN and its associated economic costs.