Amikacin dosing in the ICU: we now know more, but still not enough…

Excerpt

There are perfect studies and there are useful studies, such as the paper by de Montmollin et al. [1] in this issue of Intensive Care Medicine, which uses a simple study design to provide a strong and clinically relevant message that is very useful for daily work in the intensive care unit (ICU). Although a standard dosage of 15 mg/kg once daily is commonly used for amikacin, the authors evaluated the effect of a higher fixed weight-based amikacin dose in critically ill patients, 25 mg/kg, on achievement of concentration targets in a heterogeneous patient cohort. They found that even with a 25 mg/kg loading dose, 33 % of patients still did not achieve Cmax/MIC ratio [ratio of maximum concentration during dosing interval (Cmax) to the minimum inhibitory concentration of the known/suspected pathogen (MIC)] of 8–10, assuming the highest MIC of susceptible pathogens. …