The administration of gentamicin just before hemodialysis in dialysis patients; two cases of report

Abstract

Several studies have recommended the administration of gentamicin (GM) just before hemodialysis (HD) in dialysis patients. However, the safety and efficacy of this treatment are not well established. We herein describe two dialysis patients who were administered GM before HD. Case 1：A 67-year-old woman was administered GM following a positive blood culture for carbapenem-resistant Pseudomonas aeruginosa, and hemodiafiltration (HDF) was started 3 hours after the end of infusion. A high peak concentration of GM was achieved (C peak: 19.40μg/mL), but the trough concentration (C min) did not decrease to the safe range. Administration of GM every two HDF sessions enabled us to control the Cmin. The P. aeruginosa was eradicated from the blood culture, and the patient successfully recovered after 13 days of treatment. Case 2: A 58-year-old man was administered GM following a positive intra-abdominal abscess culture for multidrug-resistant Enterobacter aerogenes, and HD was started 30 minutes after the end of infusion. Based on the GM concentration, we adjusted the dosing and HD condition, and a satisfactory Cpeak was achieved. The Cmin was maintained in the safe range by administrating GM every HD session. These cases suggest that nonhemodialysis clearance and the HD condition might affect the Cmin in critically ill patients receiving HD and that we should frequently titrate GM administration based on frequent measurement of the GM blood concentration.