A Study on the Effect of Tobramycin Administered to Hemodialysis Patients with Systemic Infectious Disease

Abstract

Aminoglycoside antibiotics are used to manage hemo-dialysis patients after hemodialysis. Using this protocol, the serum concentration of aminoglycoside antibiotics in such patients is kept at a higher level for a long time which thus induces a toxic effect of aminoglycoside antibiotics.We administered tobramycin (TOB) 90 mg to 2 dialysis patients with infectious disease before each hemodialysis, then TOB was removed from the patients by hemodialysis after several hours.One patient was given TOB 90 mg 17 times over 33 days without any symptoms of either ototoxicity or dizziness. Another patient was given TOB 90 mg 5 times over 13 days, and his infectious condition improved markedly.The administration of aminoglycoside antibiotics before hemodialysis was thus suggested to be safe and effective for the treatment of infectious diseases in dialysis patients.We analyzed the postantibiotic effect (PAE) and the postantibiotic effect subMIC effect (PASME) of TOB for Pseudomonas aeruginosa ATCC 27853 in vitro. As a result, higher concentrations of TOB (4 MIC) and a longer exposure to it were thus found to induce stronger PAE and PASME.We therefore recommend that aminoglycoside antibiotics be given before hemodialysis in dialysis patient, and thereafter they should be removed, by hemodialysis after several hours, because high concentrations of arninoglycosides in the serum for several hours can induce stronger PAE and PASME enhance the efficacy and safety of aminoglycoside in addition to its own bacteriocidal activity.