Abstract
The objective of this article was to determine the current practice on amikacin dosing and monitoring in spinal cord injury patients from spinal cord physicians and experts. Physicians from spinal units and clinical pharmacologists were asked to provide protocol for dosing and monitoring of amikacin therapy in spinal cord injury patients. In a spinal unit in Poland, amikacin is administered usually 0.5 g twice daily. A once-daily regimen of amikacin is never used and amikacin concentrations are not determined. In Belgium, Southport (U.K.), Spain, and the VA McGuire Medical Center (Richmond, Virginia), amikacin is given once daily. Whereas peak and trough concentrations are determined in Belgium, only trough concentration is measured in Southport. In both these spinal units, modification of the dose is not routinely done with a nomogram. In Spain and the VA McGuire Medical Center, monitoring of serum amikacin concentration is not done unless a patient has renal impairment. In contrast, the dose/interval of amikacin is adjusted according to pharmacokinetic parameters at the Edward Hines VA Hospital (Hines, Illinois), where amikacin is administered q24h or q48h, depending on creatinine clearance. Spinal cord physicians from Denmark, Germany, and the Kessler Institute for Rehabilitation (West Orange, New Jersey) state that they do not use amikacin in spinal injury patients. An expert from Canada does not recommend determining serum concentrations of amikacin, but emphasizes the value of monitoring ototoxicity and nephrotoxicity. Experts from New Zealand recommend amikacin in conventional twice- or thrice-daily dosing because of the theoretical increased risk of neuromuscular blockade and apnea with larger daily doses in spinal cord injury patients. On the contrary, experts from Greece, Israel, and the U.S. recommend once-daily dosing and determining amikacin pharmacokinetic parameters for each patient. As there is considerable variation in clinical practice across spinal units and experts differ on ideal dosing and monitoring of amikacin therapy in spinal cord injury patients, there is an urgent need to develop best-practice guidelines.
Highlights
Injury to the cervical and upper dorsal spinal cord produces a variety of changes in the physiological function of different body systems
A significant increase in the volume of distribution of drugs such as the aminoglycosides, which are highly distributed into the extracellular fluid space and minimally biotransformed, may be anticipated in patients with chronic spinal cord injury[2]
Amikacin is used in the treatment of serious infections caused by gentamicin-resistant Gram-negative bacilli in spinal cord injury patients
Summary
Injury to the cervical and upper dorsal spinal cord produces a variety of changes in the physiological function of different body systems. Patients with spinal cord injury, both acute and long standing, comprise a therapeutically unique and distinct population[1]. A significant increase in the volume of distribution of drugs such as the aminoglycosides (gentamicin, amikacin, and tobramycin), which are highly distributed into the extracellular fluid space and minimally biotransformed, may be anticipated in patients with chronic spinal cord injury[2]. Amikacin is used in the treatment of serious infections caused by gentamicin-resistant Gram-negative bacilli in spinal cord injury patients. We wished to find out the degree of consensus in the use of amikacin in spinal units across Europe and the U.S we asked spinal cord physicians and experts their current practice and recommendations
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