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Clinical Chemistry 44: 408-414, 1998;
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(Clinical Chemistry. 1998;44:408-414.)
© 1998 American Association for Clinical Chemistry, Inc.

TDM Conference

Clinical outcome and economic impact of aminoglycoside peak concentrations in febrile immunocompromised patients with hematologic malignancies

Lutz Binder1,a, Xaver Schiel2, Claudia Binder2, Cristina Fernandes Almeida Menke1, Silke Schüttrumpf1, Victor W. Armstrong1, Michael Unterhalt2, Norbert Erichsen3, Wolfgang Hiddemann2, and Michael Oellerich1

1 Departments of Clinical Chemistry and
2 Hematology/Oncology, and
3 Nursing Administration, Georg-August-Universitaet Goettingen, D-37075 Goettingen, Germany.
a Author for correspondence. Fax +49-551-398072; e-mail Lbinder{at}med. uni-goettingen.de.


Abstract

The aim of this study was to investigate the clinical and economic significance of aminoglycoside peak concentrations in febrile neutropenic patients with hematologic malignancies. Sixty-one patients were treated according to protocol II of the Paul-Ehrlich-Gesellschaft: initial application of gentamicin or tobramycin in combination with a cephalosporin or ureidopenicillin and, after 3 days, a potential change of antibiosis to be decided in case of nonresponse. At the same time, samples were collected by an independent controller. We found a significant dependence of clinical outcome on aminoglycoside peak concentrations (P = 0.004). Twelve of 17 patients with peak concentrations >4.8 mg/L, but only 13 of 44 patients with concentrations <=4.8 mg/L, responded to initial therapy. Average infection-related costs per patient with peak values >4.8 mg/L were US$1429, $1790, and $1701 for nursing, diagnostics, and therapeutics, respectively (total $4920). Expenses for patients with peak concentrations <=4.8 mg/L were ~1.8-fold higher (average total $8718). If all 61 patients had achieved peaks >4.8 mg/L, the potential savings would have totalled $167 112. We conclude that neutropenic patients form a target group for successful pharmacokinetic intervention and cost saving.






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