Bioelectrical impedance is a noninvasive method used to determine body composition. Aminoglycosides are broad spectrum antibiotics that have a narrow therapeutic-to-toxic ratio. These agents have traditionally been administered using either population approaches (nomograms or Bayesian methods) or individualised pharmacokinetic monitoring, requiring blood sample analysis. Creatinine clearance is a useful measure of renal function that has been assessed using population approaches or by collecting a 12- to 24-hour urine specimen along with serum creatinine analysis. We investigated the use of bioelectrical impedance to determine predictor equations for the calculation of aminoglycoside pharmacokinetic parameters along with creatinine clearance in 20 noncritically ill patients receiving gentamicin or tobramycin. The bioelectrical impedance-derived model was able to explain >70% of the variance for half-life and total volume of distribution of aminoglycosides and >90% of the variance for creatinine clearance. Our model, when compared with a previously published model for gentamicin pharmacokinetic parameters, explained more of the variance for total volume of distribution and total body clearance. Bioelectrical impedance may be a useful tool for aminoglycoside dosing or for the determination of creatinine clearance in noncritically ill patients.
Adis International Limited Creatinine Clearance Aminoglycoside Tobramycin Drug Invest
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Gentry CA, Rodvold KA, Bertino JS Jr. Methods of minimizing the cost of aminoglycoside therapy to hospitals. Phar-macoEconomics 1993; 3: 228–43Google Scholar
Zarowitz BJ, Pilla AM, Peterson EL. Bioelectrical impedance modelling of pharmacokinetic parameters. Br J Clin Pharmacol 1989; 28: 471–8PubMedCrossRefGoogle Scholar
Zarowitz BJ, Peterson E, Popovich Jr J. Relationship of bioelectrical impedance to pharmacokinetic parameters of theophyl-line in healthy males. Clin Pharmacokinet 1989; 17: 200–7PubMedCrossRefGoogle Scholar
Zarowitz BJ, Pila AM, Popovich Jr J. Expanded gentamicin volume of distribution in patients with indicators of malnutrition. Clin Pharmacol 1990; 9: 40–4Google Scholar
Zarowitz BJ, Robert S, Mlynarek M, et al. Determination of gentamicin pharmacokinetics by bioelectrical impedance in critically ill adults. J Clin Pharmacol 1993; 33: 562–7PubMedGoogle Scholar
Kushner RF, Schoeller DA. Estimation of total body water by bioelectrical impedance analysis. Am J Clin Nutr 1986; 44: 417–24PubMedGoogle Scholar
Gibaldi M, Perrier D. In: Pharmacokinetics. 2nd ed. New York: Marcel Dekker Inc., 1982Google Scholar
Bauer LA, Gibaldi M. Computation of model-independent pharmacokinetic parameters during multiple dosing. J Pharm Sci 1983; 72: 978–9PubMedCrossRefGoogle Scholar
SAS Institute Inc. SAS/STAT User’s Guide, Version 6. 4th ed. Cary, NC: SAS Institute Inc., 1989Google Scholar
Chatterjee S, Price B. In: Regression analysis by example. 2nd ed. New York: Wiley Publications, 1991: 234Google Scholar
Cocchetto DM, Tschanz C, Bjornsson TD. Decreased rate of creatinine production in patients with hepatic disease: implications for estimation of creatinine clearance. Ther Drug Monit 1983; 5: 161–8PubMedCrossRefGoogle Scholar
Hull JH, Sarubbi FA. Gentamicin serum concentrations: phar-macokinetic predictions. Ann Intern Med 1976; 85: 183–9PubMedGoogle Scholar
Etzel JV, Nafziger AN, Bertino Jr JS. Variation in the pharma-cokinetics of gentamicin and tobramycin in patients with pleural effusions and hypoalbuminemia. Antimicrob Agents Chemother 1992; 36: 679–81PubMedCrossRefGoogle Scholar
Levy J, Smith AL, Koup JR, et al. Disposition of tobramycin in patients with cystic fibrosis: a prospective controlled study. J Pediatr 1984; 105: 117–24PubMedCrossRefGoogle Scholar
Zaske DE, Cippolle RJ, Strate RG, et al. Increased gentamicin dosage requirements: rapid elimination in 248 gynecology patients. Am J Obstet Gynecol 1981; 139: 896–900PubMedGoogle Scholar
Zaske DE, Sawchuck RJ, Gerding DN, et al. Increased dosage requirements of gentamicin in burn patients. J Trauma 1976; 16: 824–38PubMedCrossRefGoogle Scholar
Lau A, Berk SI, Prosser T, et al. Estimation of creatinine clearance in malnourished patients. Clin Pharm 1988; 7: 62–5PubMedGoogle Scholar
O’Connell MB, Dwinell AM, Barnick-Mohrland DB. Predictive performance of equations to estimate creatinine clearance in hospitalized elderly patients. Ann Pharmacother 1992; 26: 627–35PubMedGoogle Scholar