Four-hour microbiological assay of gentamicin in serum

High-performance liquid chromatographic determination of netilmicin in guinea-pig and human serum by fluorodinitrobenzene derivatization with spectrophotometric detection

A high-performance liquid chromatographic procedure for netilmicin determination in guinea-pig and human serum using pre-column derivatization with 1-fluoro-2,4-dinitrobenzene and UV detection is described. Linearity was established over the range 0.5-40 micrograms/ml using only 50 microliters of serum. Accuracy and precision were good, with a mean coefficient of variation less than 5% and a mean relative error less than 4%. This procedure correlates well with an enzyme multiplied immunoassay technique and has a sensitivity similar to those of published fluorescence derivatization methods.

Why monitor serum levels of gentamicin?

Although it is widely recommended that serum levels of aminoglycoside antibiotics be monitored by assay, the justification for this approach has not been clearly presented. A number of studies indicate that serum levels of these agents cannot be predicted reliably on the basis of simple dosage formulae; the major confounding factors being abnormalities of renal function and of extracellular fluid volume in addition to less well defined variables such as fever and anaemia. The influence of haemodialysis and concomitant administration of carbenicillin further complicate dosage estimations in patients with renal insufficiency. On the basis of currently available data, it is reasonable to suggest an optimum range of 5 to 8 microgram/ml for peak serum levels of gentamicin. There are no reliable studies from which to derive a comparable value for trough (pre-dose) concentrations. The relative importance of peak and trough values for nephrotoxicity and ototoxicity is an unresolved subject of controversy. However, it seems possible that neither of these individual values, but rather the 'area under the time-concentration curve' is the major risk factor for toxicity. In view of the unpredictability of serum levels, especially in seriously ill patients in a fluctuating physiological state, periodical serum gentamicin assays should be performed. The main objective of these assays is to ensure that the peak serum levels attained are adequate, but not unnecessarily high.

Gas-liquid chromatographic method for the assay of aminoglycoside antibiotics in serum

A gas-liquid chromatographic (GLC) method is presented for the rapid analysis of gentamicin, tobramycin, netilmicin, and amikacin from human serum. This procedure may have application to all aminoglycoside drugs. The three isomers of gentamicin are resolved as two bands, while tobramycin, netilmicin, and amikacin appear in this system as single bands. Normal serum constituents do not interfere with chromatograms. Thus far, no assay interference has been found in cases where other drugs and antibiotics were administered concurrently with aminoglycoside therapy. Dose-response data demonstrating linear recovery are included for all four aminoglycosides as well as a comparison of the GLC method with the microbiological method for the assay of gentamicin and amikacin. Quantitation is based upon the relative response of the antibiotics to a fixed amount of the internal standards, either kanamycin A or paromomycin B. These standards are clearly resolved as symmetrical peaks from the antibiotics of assay interest. Isothermal chromatographic analysis time is less than 8 min, while total assay time per single serum specimen is approximately 50 min. Preparation of serum includes: precipitation, evaporative drying of the supernatant, a two-stage derivatization (N-trimethylsilylimidazole, N-heptafluorobutyrylimidazole), and a single hexane extraction with a water wash. The methodology described may be applied to the analysis of other compounds (e.g., saccharides, amino-saccharides, amino acids, etc.) which do not rapidly partition into an organic phase.

Assay of gentamicin concentrations in serum specimens by microbiological and radioenzymatic methods

Assay of gentamicin concentrations were performed on 167 patient sera by two methods in the routine work. A radioenzymatic method that measures the acetylation of getamicin by a bacterial enzyme extract and the overnight agar diffusion method, using cups as diffusion centres, were used. The methods correlated well (r = 0.87), although the results of the microbiological assay in some cases were higher than the results of the enzymatic assay. When artificial samples were tested the microbiological methods gave variable results. Therefore careful standardization is necessary for accuracy and reproducibility. The enzymatic assay, however, offered advantages of specificity, reproducibility and rapidity.

Antibiotic synergy and antagonism against clinical isolates of Klebsiella species

Minimal inhibitory concentrations of kanamycin, gentamicin, amikacin, cephalothin, and chloramphenicol were determined in Trypticase soy broth for 70 clinical isolates of Klebsiella species. Gentamicin and amikacin were the most active on a weight basis. Chloramphenicol was more active than kanamycin, and cephalothin was the least active of all. Studies using a microtiter modification of the checkerboard technique were performed to evaluate the comparative activity of the three aminoglycosides in combination with either chloramphenicol or cephalothin. The cephalothin-aminoglycoside combinations demonstrated synergy in >80% of the isolates tested. No antagonism was noted. The chloramphenicol-aminoglycoside combinations showed antagonism in 35 to 45% of the isolates tested. The data suggest that the chloramphenicol-aminoglycoside combinations be used with caution when treating serious infections where Klebsiella is a potential pathogen.

Gentamicin in ophthalmology

Gentamicin, widely used in the treatment of ocular infections, is discussed in terms of its chemical structure, effectiveness against various organisms, and pharmacology. Dosages and methods of administration are detailed and toxic effects, reversible and irreversible, are noted.

Modification of antibiotic resistance in gram-negative bacteria by penicillinase inhibition

The correlation coefficient between the rapid enzymatic and the overnight microbiological assays for 211 urine and serum specimens was 0.96. The 95% confidence limits yielded a correlation coefficient between 0.92 and 0.98. Both methods tended to underestimate the amount of a gentamicin added to urine. When only serum samples were considered, the predicted value obtained from the linear regression analysis of either method was within 0.57 μg/ml 99% of the time. This high degree of positive correlation will permit safe rapid adjustment of individualized patient gentamicin dosages.

Rapid gentamicin bioassay using a multiple-antibiotic-resistant strain of Klebsiella pneumoniae

A rapid bioassay for gentamicin levels in serum was developed by using a strain of Klebsiella pneumoniae that has multiple resistance to antibiotics. Assays were comparable when performed on either small or large petri plates, and results were available in 2 to 4 h. Studies showed an overall recovery of 97.6% for gentamicin alone or 104.5% in the presence of commonly used antibiotics. The procedure can be performed without the need to inactivate other antibiotics that may be present in the serum sample.