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Volume 6, Pages 187-199
Discussion Paper

Amikacin Dosing and Monitoring in Spinal Cord Injury Patients: Variation in Clinical Practice Between Spinal Injury Units and Differences in Experts' Recommendations

1Regional Spinal Injuries Centre, District General Hospital, Southport, Merseyside PR8 6PN, UK
2Pharmacokinetics Laboratory, Rm. K-424a, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA
3Centrum Urologische Revalidatie, Universitair Zieckenhuis Antwerpen, 10 Wilrijkstraat, B 2650 Edegem, Belgium
4Metropolitan Rehabilitation Centre, Department of Neuro-Urology, Konstancin, Poland
5Medical Intensive Care Unit, Soroka University Medical Center, P.O.B. 151, Beer-Sheva 84101, Israel
6Laboratory of Biopharmaceutics and Pharmacokinetics, School of Pharmacy, University of Athens, Panepistimiopolis 15771, Athens, Greece
7VA McGuire Medical Center, 1201 Broad Rock Blvd, Richmond, VA 23113, USA
8Pharmacy Service, Edward Hines VA Hospital, Hines, IL 60141, USA
9Neurorehabilitation Hospital Institut Guttmann, Barcelona, Spain

Received 8 November 2005; Revised 1 May 2006; Accepted 2 May 2006

Academic Editor: Orest Hurko

Copyright © 2006 Subramanian Vaidyanathan et al.


The objective of this article was to determine the current practice on amikacin dosing and monitoring in spinal cord injury patients from spinal cord physicians and experts. Physicians from spinal units and clinical pharmacologists were asked to provide protocol for dosing and monitoring of amikacin therapy in spinal cord injury patients. In a spinal unit in Poland, amikacin is administered usually 0.5 g twice daily. A once-daily regimen of amikacin is never used and amikacin concentrations are not determined. In Belgium, Southport (U.K.), Spain, and the VA McGuire Medical Center (Richmond, Virginia), amikacin is given once daily. Whereas peak and trough concentrations are determined in Belgium, only trough concentration is measured in Southport. In both these spinal units, modification of the dose is not routinely done with a nomogram. In Spain and the VA McGuire Medical Center, monitoring of serum amikacin concentration is not done unless a patient has renal impairment. In contrast, the dose/interval of amikacin is adjusted according to pharmacokinetic parameters at the Edward Hines VA Hospital (Hines, Illinois), where amikacin is administered q24h or q48h, depending on creatinine clearance. Spinal cord physicians from Denmark, Germany, and the Kessler Institute for Rehabilitation (West Orange, New Jersey) state that they do not use amikacin in spinal injury patients. An expert from Canada does not recommend determining serum concentrations of amikacin, but emphasizes the value of monitoring ototoxicity and nephrotoxicity. Experts from New Zealand recommend amikacin in conventional twice- or thrice-daily dosing because of the theoretical increased risk of neuromuscular blockade and apnea with larger daily doses in spinal cord injury patients. On the contrary, experts from Greece, Israel, and the U.S. recommend once-daily dosing and determining amikacin pharmacokinetic parameters for each patient. As there is considerable variation in clinical practice across spinal units and experts differ on ideal dosing and monitoring of amikacin therapy in spinal cord injury patients, there is an urgent need to develop best-practice guidelines.