Amikacin dosing in the ICU: We now know more, but still not enough...

摘要

Firstly, the weight metric selected by the authors was total body weight and not an adjusted dosing weight, which is considered more appropriate, particularly for obese patients. Secondly, there are patients with acute kidney injury as well as patients treated with continuous renal replacement therapy which should require a slightly reduced loading dose compared with patients with better renal function. Thirdly, there was an insufficient patient enrolment to determine microbiological outcomes associated with altered concentrations. Finally, no analyses were provided to show how a clinician can overcome the inadequacies of a fixed dosing approach or even what dose should be used. Here a population pharmacokmetic analysis with dosing simulations would be preferred, but is unfortunately not possible with the current study design.