1987. Pharmacokinetics of Intravenous Amikacin in Intermittent Hemodialysis: Treatment of Peritoneal Dialysis Peritonitis caused by Nontuberculous Mycobacterium (NTM)
Session: Poster Abstract Session: Antimicrobial Pharmacokinetics and Pharmacodynamics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Amikacin PD peritonitis poster FINAL.pdf (766.7 kB)
  • Background: Data on aminoglycoside (AG) pharmacokinetics (PK) in intermittent hemodialysis (iHD) is outdated; current practice employs more efficient iHD modalities. Once-daily AG are used to optimize treatment of resistant organisms including non-tuberculous mycobacterium (NTM). Currently recommended amikacin dosing (3-5 mg/kg post-iHD) is unlikely to obtain IDSA-recommended target Cmax for NTM (20-30mg/L). Recently, experts have suggested gentamicin dosed pre-iHD can attain maximal peak to optimize PK/PD goals; using iHD to decrease overall exposure to avoid toxicity. No PK data has described pre-iHD dosing strategy for high-dose amikacin, so it remains uncommonly practiced.

    Methods: We describe a high-dose strategy of IV amikacin and PK monitoring (efficacy and toxicity) in 2 cases of peritoneal dialysis peritonitis caused by NTM. Amikacin was dosed at 7mg/kg on iHD days, given 4 hours pre-iHD to allow distribution. Amikacin levels were drawn: prior to iHD (peak); 4 hours post-iHD (trough); and prior to next dose administration (“true trough” to assess non-iHD clearance). PK analysis was performed assuming one compartment, linear kinetics.

    Results: See Figure 1 and Figure 2

    Conclusion: Pre-iHD amikacin 7mg/kg achieved IDSA-recommended Cmax for treatment of NTM peritonitis. Amikacin clearance with current iHD modalities was much more efficient than prior reports. High-dose, pre-iHD administration strategy successfully improved PK/PD parameters, allowing high Cmax, while decreasing overall amikacin exposure on non-iHD days. We suggest pre-iHD amikacin dosing for iHD patients who require high-dose therapy for optimal attainment of Cmax targets in serious infections.

    Francine Kwee, BScH, BScPharm, St. Michaels Hospital/University of Toronto, Toronto, ON, Canada, Nisha Andany, MD, FRCPC, Department of Medicine, University of Toronto, Toronto, ON, Canada, Jeffrey Perl, MD, SM, FRCPC, Division of Nephrology, St. Michaels Hospital, Toronto, ON, Canada and Elizabeth Leung, PharmD, BCPS AQ-ID, Infectious Diseases/Antimicrobial Stewardship, St. Michaels Hospital, Toronto, ON, Canada

    Disclosures:

    F. Kwee, None

    N. Andany, None

    J. Perl, None

    E. Leung, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.