On 29 May 1996 at 10:29:14, "Dianne M. Brundage" (brund004.at.maroon.tc.umn.edu) sent the message
There wasn't any literature on once daily aminoglycosides in febrile neutropenia
when I recently searched. We've been utilizing it in our chemotherapy-induced
neutropenia patients (both inpatient and outpatient management), but counts
return quickly to normal (we also use filgrastim) so I'm not sure this is a true
test. Our physicians and nurses like it. We have relatively limited experience
in AML patients s/p chemotherapy, however, it appears to be no different from
conventional dosing. Our experience with impaired renal function (ie dosing q48
hours) is also very limited. Usually, we do not use it as monotherapy against
gram negative organisms, and we have very few resistant gram negative organisms.
In message writes:
> PharmPK - Discussions about Pharmacokinetics
> Pharmacodynamics and related topics
>
> pharmpk PK/PD Discussion LISTSERV
>
> I apologise for raising an issue which has been discussed extensively in
> the not too distant past.
>
> My question is whether there are literature data (or personal experiences)
> to support the use of ODA in patients with chemotherapy induced
> neutropenic sepsis, where overwhelming gram -ve septicaemia can develop
> rapidly in the absence of appropriate antibiotic therapy.
>
> Duncan Jodrell
> Senior Lecturer in Medical Oncology
>
> from: Duncan Jodrell
> see WWW Server at: http://www.cpb.uokhsc.edu/pkin/pkin.html for more info
>
> Also see: http://www.cpb.uokhsc.edu/pkin/pkin.html
>
Dianne M. Brundage, Pharm.D., BCPS
Methodist Hospital Pharmacy
6500 Excelsior Blvd
Minneapolis, MN 55426
Phone: 612-993-6374
Digital pager: 612-534-8003
Fax: 612-993-6813
brund004.-a-.maroon.tc.umn.edu
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On 31 May 1996 at 10:59:39, G.Peterson.-at-.pharm.utas.edu.au (Greg Peterson) sent the message
>PharmPK - Discussions about Pharmacokinetics
> Pharmacodynamics and related topics
>
>pharmpk PK/PD Discussion LISTSERV
>
>I apologise for raising an issue which has been discussed extensively in
>the not too distant past.
>
>My question is whether there are literature data (or personal experiences)
>to support the use of ODA in patients with chemotherapy induced
>neutropenic sepsis, where overwhelming gram -ve septicaemia can develop
>rapidly in the absence of appropriate antibiotic therapy.
>
>Duncan Jodrell
>Senior Lecturer in Medical Oncology
Hi Duncan,
The following very recent paper might be of some interest - perhaps you
have seen it already.
Author(s) R Hatala, T Dinh, DJ Cook
Title Once-daily aminoglycoside dosing in immunocompetent adults: A
meta-analysis
Source Annals of Internal Medicine 124: 8 (APR 15 1996)
Page(s) 717
Author KW meta-analysis; dose-response relationship, drug;
antibiotics, aminoglycoside; drug administration schedule; bacterial
infections
KeyWords+ GRAM-NEGATIVE INFECTIONS; DAILY NETILMICIN REGIMENS;
CRITICALLY ILL ADULT; DAILY AMIKACIN; SYSTEMIC INFECTIONS; SERIOUS
INFECTIONS; PEDIATRIC-PATIENTS; CLINICAL-TRIALS; RISK-FACTORS; A-DAY
Abstract Objective: To compare the efficacy, nephrotoxicity, and
ototoxicity of once-daily aminoglycoside dosing with those of standard
aminoglycoside regimens in immunocompetent adults.
Data Sources: A structured MEDLINE search from 1966 to April 1995 using the
keywords aminoglycosides, drug administration schedule, and adult;
bibliographic searching of review articles, position papers, and references
of the selected articles; contact with primary authors of selected articles
to obtain information not in the published reports and lists of potentially
relevant articles.
Study Selection: Randomized, controlled trials that 1) compared an
intravenous once-daily aminoglycoside regimen with a standard
aminoglycoside regimen in infected immunocompetent adults and 2) examined
efficacy, mortality, or toxicity.
Data Extraction: For each selected study, two indepen dent reviewers
assessed methodologic quality and abstracted data. The heterogeneity of
individual study risk ratios was assessed and data were pooled using a
random-effects model.
Results: Forty-two studies were reviewed for possible inclusion. Thirteen
independent studies met the selection criteria, and their results were
pooled. The trials had a mean methodologic quality score of 0.69 (range,
0.50 to 0.91). Heterogeneity exists among the individual risk ratios for
clinical cure (P = 0.07); significant heterogeneity does not exist for the
other outcomes. For the pooled efficacy outcomes, the risk ratio for
bacteriologic cure is 1.02 (95% CI, 0.99 to 1.05), and the risk ratio for
mortality is 0.91 (CI, 0.63 to 1.31). For the pooled toxicity outcomes, the
risk ratio for nephrotoxicity is 0.87 (CI, 0.60 to 1.26), and the risk
ratio for ototoxicity is 0.67 (CI, 0.35 to 1.28).
Conclusions: Standard and once-daily aminoglycoside dosing regimens are
equivalent with regard to bacteriologic cure, and once-daily dosing shows a
trend toward reduced mortality and toxicity. However, additional studies
are needed for more precise estimates of mortality and toxicity risk
ratios. The equivalency of the dosing regimens, the ease of administration,
reduced nursing time, and reduced variability in the timing of drug
administration that are associated with once-daily dosing may mean that the
once-daily regimen is clinically advantageous.
Greg
Gregory Peterson
Senior Lecturer
Tasmanian School of Pharmacy
University of Tasmania GPO Box 252C
Hobart, TAS, 7001 AUSTRALIA
Telephone: 002 202197 or 015 875 378
Facsimile: 002 202870
E-mail: G.Peterson.aaa.pharm.utas.edu.au
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