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Antibiotics


Definition


  • Antibiotics are substances that destroy or inhibit the growth of microorganisms. Antibiotics consist of chemical groups such as Ž ²-lactams, polyenes, macrolides, tetracyclines, aminoglycosides, and sulfonamides. Names include amikacin, chloramphenicol, gentamicin, kanamycin, streptomycin, tobramycin, and vancomycin.
  • Normal therapeutic (and toxic) levels: see Table 16.5.

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TABLE 16 " “5Therapeutic and Toxic Serum Concentrations for AntibioticsView LargeTABLE 16 " “5Therapeutic and Toxic Serum Concentrations for Antibiotics Therapeutic Concentration ( ‚ µmg/mL) Potentially Toxic Level ( ‚ µg/mL) Amikacin " ƒPeak 15 " “25 >30 " ƒTrough 2 " “5 >8 Chloramphenicol " ƒPeak 10 " “20 25 " ƒTrough 5 " “10 15 Gentamicin " ƒPeak 5 " “10 12 " ƒTrough 0.5 " “2 >2 Kanamycin " ƒPeak 20 " “25 " ƒTrough 5 " “10 Netilmicin " ƒPeak 4 " “8 8 " ƒTrough 1 " “2 2 Streptomycin " ƒPeak 5 " “20 40 " ƒTrough <5 40 Tobramycin " ƒPeak 5 " “10 12 " ƒTrough 0.5 " “2 >2 TMP/SMX " ƒPeak (TMP) 4 " “8 8 " ƒPeak (SMX) 1 " “2 >2 Vancomycin " ƒPeak (not recommended) 30 " “40 >80 " ƒTrough 5 " “10 >20

Use


  • Prevention and treatment of infections caused by bacteria

Limitations


  • Testing must be performed on serum or plasma.
  • Peak concentrations: collect specimen 30 " “120 minutes after completion of infusion (drug and route dependent).
  • Trough concentrations: collect specimen 5 " “90 minutes before next infusion (drug dependent).
  • Testing methodologies: immunoassay (e.g., fluorescence polarization) or HPLC.
  • Specimens must be frozen for streptomycin and amphotericin B.
  • Specimens must be protected from light for trimethoprim and amphotericin.
  • Unacceptable specimens:
    • Hemolyzed
    • Collection tubes with additives such as serum separator, citrate, oxalate, or fluoride
  • Trimethoprim may be detected in urine in general toxicology screens utilizing GC/MS.
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