A meta-analysis of the target trough concentration of gentamicin and amikacin for reducing the risk of nephrotoxicity. Issue 2 (February 2021)

• Record Type: Journal Article
• Authors: Yamada, Tomoyuki; Fujii, Satoshi; Shigemi, Akari; Takesue, Yoshio
• Is Part Of: Journal of infection and chemotherapy. Volume 27:Issue 2(2021)
• Page Start: 256
• Page End: 261
• Publication Date: 2021-02
• Subjects: Amikacin -- Aminoglycoside -- Gentamicin -- Meta-analysis -- Nephrotoxicity -- Therapeutic drug monitoring; AGs aminoglycosides -- AKI acute kidney disease -- AMK amikacin -- CI confidence interval -- Cmin trough concentration -- GM gentamicin -- JSC Japanese Society of Chemotherapy -- JSTDM Japanese Society of Therapeutic Drug Monitoring -- NOS Newcastle–Ottawa Scale -- OR odds ratio -- RCT randomized controlled trial -- SE standard error -- TDM therapeutic drug monitoring -- TOB tobramycin; Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2020.09.033
• Languages: English
• ISSNs: 1341-321X

Abstract

Abstract: Introduction: Antimicrobial resistance is one of the biggest threats to public health systems worldwide, and aminoglycosides are key drugs for treating drug-resistant infections. Because of the nephrotoxicity of aminoglycosides, therapeutic drug monitoring is recommended, but few studies of the target trough concentration (Cmin) have been reported. To address the problem, we performed a meta-analysis to confirm the target Cmin of aminoglycosides for minimizing the risk of nephrotoxicity. Methods: We conducted a literature search using MEDLINE, the Cochrane Library, and Ichushi-Web. In the meta-analysis, nephrotoxicity was compared between the Cmin ≥2 mg/L and Cmin <2 mg/L groups for gentamicin and between the Cmin ≥10 mg/L and Cmin <10 mg/L groups for amikacin. Results: No randomized controlled trials were reported for any of the drugs. Five observational studies involving 615 patients were reported for gentamicin, and two observational studies involving 159 patients were identified for amikacin. For gentamicin, Cmin <2 mg/L was linked to a significantly lower rate of nephrotoxicity than Cmin ≥2 mg/L (odds ratio [OR] = 0.22, 95% confidence interval [CI] = 0.12–0.40). For amikacin, Cmin <10 mg/L was associated with a significantly lower rate of nephrotoxicity than Cmin ≥10 mg/L (OR = 0.05, 95% CI = 0.01–0.21). Conclusions: Although further well-controlled studies with a low risk of bias are needed, the current meta-analysis demonstrated that Cmin <2 mg/L and Cmin <10 mg/L may reduce the risk of nephrotoxicity linked to gentamicin and amikacin, respectively.