Background New guidelines for the use of aminoglycosides were published by French National Health Authority in March 2011 . They recommended 3–5 mg/kg/d for 48–72 h. Before, aminoglycosides doses were reduced in line with the creatinine clearance, which is frequently reduced in elderly patients.
Purpose To determine whether aminoglycoside treatment conformed to the guidelines. If not, the risks are a reduction in antibiotic effectiveness and the development of bacterial resistance among a vulnerable population.
Materials and Methods Elderly patients hospitalised in an acute geriatric unit or in a follow-up and rehabilitative care ward were included in a retrospective study with 2 inclusion periods: 3 months before and 3 months after the guidelines were issued. Student’s t test was used to compare the mean dose and average duration of gentamicin with the guidelines and compare gentamicin treatment before and after the guidelines.
Results 88 patients were included in the study period. Both groups (before/after) were similar in terms of age, weight and creatinine clearance (Cockroft and Gault formula). The main aminoglycoside used was gentamicin (97.7%) (mostly with ceftriaxone). Before the recommendations, the mean gentamicin dose was 2.0 ± 0.7 mg and mean gentamicin duration was 2.4 ± 0.6 days. After the recommendations, the mean dose was 2.2 ± 0.9 mg and mean gentamicin duration was 2.4 ± 1.1 days. After the recommendations: 78% of gentamicin prescriptions were consistent with the recommended duration; 30% of prescriptions followed the recommended dose; the average dose of gentamicin differed significantly from the recommended dose (p < 0.001); 24% of gentamicin treatments were consistent with recommendations. Average dose and duration of gentamicin did not significantly differ before and after the publication of the recommendation (p > 0.05).
Conclusions Only 24% of geriatric patients have consistent gentamicin treatment. Guidelines did not change doctor’s habits about gentamicin. We should now implement a new strategy for informing the medical staff, communication inside the institution and question their knowledge and make representations about kidney damage due to gentamicin. Clinical pharmacy should also be developed in order to help to improve the use of medicines.
Afssaps, Mise au point sur le bon usage des aminosides administrés par voie injectable, Mars 2011.
No conflict of interest.
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