AI Article Synopsis
- Amikacin is recommended for treating urinary tract infections (UTIs) caused by multi-resistant pathogens, but its effectiveness depends on achieving high concentrations in urine, particularly in patients with low kidney function.
- A study of 70 patients with varying levels of kidney function found that those with lower glomerular filtration rates (GFR) had significantly lower levels of amikacin in their urine, affecting its efficacy.
- The findings indicate that amikacin treatment may be ineffective in dialysis patients due to urine concentrations often being below the required threshold for treatment effectiveness.
Article Abstract
Background: Amikacin monotherapy is recommended for urinary tract infection (UTI) treatment with multi-resistant pathogens. Even though amikacin efficacy in the treatment of UTIs is dependent on its urinary concentration, there are no robust data proving that sufficiently high urinary concentration is reached in patients with reduced glomerular filtration rate (GFR).
Methods: A prospective study to monitor amikacin penetration into urine of 70 patients [40 males, median (interquartile range) age 70 (65-79) years] with different levels of glomerular filtration decline, including patients treated by dialysis, was conducted. The bactericidal efficacy of amikacin in urine samples has been evaluated.
Results: Patients with estimated GFR (eGFR) <30 mL/min had significantly lower median amikacin urinary concentration than patients with eGFR >30 mL/min (89.75 vs 186.0 mg/L, < .0001; 200.5 vs 830.0 mg/L, < .0001; and 126.0 vs 408.0 mg/L, < .0001 for minimal, maximal and minimal together with maximal concentrations, respectively). The amount of amikacin eliminated in the first 10-13 h after dose administration was dependent on eGFR (r = 0.6144, < .0001). The urinary concentration of amikacin in patients treated by dialysis was indirectly proportional to pH of urine. The plasma concentrations of amikacin did not correlate with urinary levels in patients in either of the GFR categories. Microbiological evaluation showed that the critical urinary concentration for efficacy of amikacin during UTI monotherapy in patients treated by dialysis is 100 mg/L. We found that 4 out of 11 patients treated by dialysis did not reach this level during the treatment.
Conclusion: Systemic administration of amikacin monotherapy in patients treated by dialysis is questionable as the concentrations of amikacin in their urine are often below the threshold of effectivity. Amikacin plasma concentrations are not a major determinant of amikacin concentration in urine, therefore pulse dosing is neither necessary nor safe in patients treated by dialysis, and may cause undesirable toxicity.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802929 | PMC |
| http://dx.doi.org/10.1093/ckj/sfae002 | DOI Listing |
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