Estimating aminoglycoside clearance and creatinine clearance in underweight patients

February 2010
American Journal of Health-System Pharmacy;2/15/2010, Vol. 67 Issue 4, p274
Academic Journal
Purpose. An adjustment factor (AF) was developed and evaluated to determine the best method for estimating aminoglycoside clearance (CLamino) and creatinine clearance (CLcr) in underweight patients. Methods. This study was a retrospective, multicenter, chart analysis of aminoglycoside pharmacokinetic data obtained between January 2000 and August 2006 at the University of Southern California University Hospital and Cedars-Sinai Medical Center. Adult patients were included in this study if they had received inpatient aminoglycoside therapy, were at least 60 inches tall, and were at least 10% below their ideal body weight (IBW). CLcr and CLamino were estimated and compared to actual CLamino using the Cockcroft-Gault equation with actual serum creatinine (SCr) (CGSCr), Cockcroft-Gault equation with SCr rounded to 1 mg/dL (CGrnd), and Cockcroft-Gault equation multiplied by an AF (CGAF). Results. An AF of 0.69 was determined from 52 patients and tested in 53 separate patients. The CGAF method was more precise and less biased than the CGSCr equation; the CGrnd equation was less biased than the CGSCr equation; the CGAF method was more precise and less biased than the CGrnd equation, but this difference was not statistically significant. In underweight patients with an SCr concentration of ≥1 mg/dL, the CGAF method had less bias compared with the CGSCr equation. Conclusion. Both the CGrnd and CGAF methods of predicting CLamino in underweight patients were superior to the CGSCr equation. The CGAF method was more accurate in patients exhibiting greater differences between IBW and actual body weight.


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