ゲンタマイシンの高用量投与が有効であった感染性心内膜炎の一症例

概要

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A 25-year-old woman diagnosed to have infective endocarditis by Haemophilus aphrophilus was treated with gentamicin (GM). An initial GM dose of 40 mg was infused over a period of 1h three times a day. The pharmacokinetic analysis of GM was carried out according to a 1-compartment model by using the Bayesian estimation method. In the pharmacokinetic analysis, the 1h-infusion of 100mg GM 4 times a day was adopted in order to obtain serum concentrations of 6〜10μg/mL as the estimated peak levels and less than 2 μg/mL as the trough levels, respectively. The GM therapy was continued for 38 days. The final serum concentrations of 8.4μg/mL as the peak levels and I . 4μg/mL as the through levels were obtained. At 38days from the start of GM therapy, infective endocarditis was diagnosed as cured after symptoms of stroll appeared. After the administration of GM was stopped and any unexpected episodes were treated, all symptoms of unsteadiness disappeared. It is thus possible to administer high doses of GM, by performing TDM which allows us to avoid any irreversible adverse events and thus help the patients to recover. In addition, GM should be administered 4 times a day, to allow high density GM to reach the heart in the above case in a timely manner.
日本医療薬学会の論文
2001-08-10