There appears to be some inconsistencies in our values as to what is the recommended Amikacin Trough when we are using High-dose amikacin (15-20mg/kg) once daily. I believe the goal would be to have no measureable level. If that is less than 1mg/L then I would support that. I don’t know if we have any evidence that less than 3 is more toxic than less than 1.
I think less than one is the ideal target, given that HEDI (high dose extended interval) takes advantage of aminoglycosides’ pk/pd characteristics including the postantibiotic effect.
But as for needed a trough in HEDI I would lean towards the Hartford method of monitoring and adjusting (level 8-12 hours post) as your trough could be 0 for 6 hours or 2 minutes which I would think would have an impact on efficacy and toxicity.