[Calculation of the first dose of amikacine: evaluation of the current dosage recommendations].

Aminoglycosides, including amikacin, are antibiotics with major interest in the management of sepsis, but with a high potential toxicity. The French national recommendations revised in 2011 recommend a dose of amikacin ranging from 15 to 30 mg/kg. The objective was to assess if such a dose interval allows reaching the efficiency target concentrations of 64 mg/L without exceeding the toxic threshold of 2.5mg/L. From a cohort of 100 patients treated with amikacin, the individual pharmacokinetic parameters were estimated using pharmacokinetic software (MM-USCPACK). Peak and residual concentrations obtained after simulated doses ranging from 15 to 30 mg/kg were estimated and compared with the effective and toxic thresholds. The optimum dose to achieve precisely the efficiency target was calculated for each patient. Patients studied had a mean age of 79 years, mean weight of 58 kg, and mean creatinine clearance of 45 mL/min. The dose of 30 mg/kg allows the achievement of an effective peak in 98.7% of patients, but led to a potentially toxic through for 72.4% of them. The optimal dose was at mean of 1264 mg, significantly different than doses calculated with weight (P<0.0001). A weak correlation was found between weight and the optimal dose. A fixed dose of 30 mg/kg seems to be effective for most patients, but often excessive and leads to a toxic residual to 72% of patients, whereas 15 mg/kg was insufficient for most patients. The low correlation between optimal dose and patient weight shows that weight does not explain fully the interindividual variability.