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首页> 美国卫生研究院文献>The Scientific World Journal >Amikacin Dosing and Monitoring in Spinal Cord Injury Patients: Variation in Clinical Practice Between Spinal Injury Units and Differences in Experts Recommendations
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Amikacin Dosing and Monitoring in Spinal Cord Injury Patients: Variation in Clinical Practice Between Spinal Injury Units and Differences in Experts Recommendations

机译：丁胺卡那霉素在脊髓损伤患者中的剂量和监测：脊髓损伤单位之间的临床实践差异和专家建议中的差异

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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.
机译：本文的目的是确定来自脊髓内科医生和专家的阿米卡星剂量和监测在脊髓损伤患者中的现行做法。要求来自脊髓科的医师和临床药理学家提供用于脊髓损伤患者的阿米卡星治疗的剂量和监测方案。在波兰的一个脊髓单位中，丁胺卡那霉素通常每天两次服用0.5 g。从未使用过每日一次的阿米卡星治疗方案，也未确定阿米卡星的浓度。在比利时，英国的绍斯波特和西班牙的弗吉尼亚州麦克里尔医学中心（VA McGuire Medical Center），每天服用一次丁胺卡那霉素。尽管在比利时确定了峰谷浓度，但在绍斯波特仅测量了谷浓度。在这两个脊柱单位中，剂量的改变通常不是通过诺模图进行的。在西班牙和VA McGuire医学中心，除非患者有肾功能不全，否则不进行血清阿米卡星浓度的监测。相反，在爱德华·海因斯VA医院（伊利诺伊州海因斯），根据药代动力学参数调整丁胺卡那霉素的剂量/间隔，其中依肌酐清除率在第24小时或第48h给予丁胺卡那霉素。来自丹麦，德国和凯斯勒康复研究所（新泽西州西奥兰治）的脊髓科医生表示，他们在脊髓损伤患者中不使用丁胺卡那霉素。加拿大的专家不建议确定阿米卡星的血清浓度，但强调监测耳毒性和肾毒性的价值。来自新西兰的专家建议在传统的每日两次或三次每天剂量中使用丁胺卡那霉素，因为理论上在脊髓损伤患者中每天增加大剂量的神经肌肉阻滞和呼吸暂停的风险会增加。相反，希腊，以色列和美国的专家建议每天一次给药，并确定每位患者的阿米卡星药代动力学参数。由于整个脊柱单位的临床实践存在很大差异，并且专家对脊髓损​​伤患者的阿米卡星治疗的理想剂量和监测存在分歧，因此迫切需要制定最佳实践指南。

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