Increased Glomerular Filtration Rate in Patients with Major Burns and Its Effect on the Pharmacokinetics of Tobramycin

Abstract

The clearance of endogenous creatinine in 20 burned patients, measured between the fourth and the 35th post-burn day, was a mean (± S.D.) of 172.1 ±48.4 ml per minute per 1.73 m²; in eight normal subjects the mean value was 125.4±10.4 (P<0.02). Thirteen patients had values more than 2 S.D. above the normal mean. We confirmed this rise in glomerular filtration rate by measuring inulin or iothalamate clearance in nine patients.

The pharmacokinetics of tobramycin were studied in 11 of the 20 patients and in eight normal subjects receiving continuous intravenous infusions of the drug. An inverse correlation was found between plasma half-life of the drug and creatinine clearance (r = -0.68, P<0.01). Increased creatinine clearances and shortened half-life of tobramycin occurred mainly in younger patients.

Glomerular filtration rates in burned patients may rise to very high values and can be validly measured by creatinine clearance. The plasma half-lives of drugs with predominantly urinary excretion may decrease in patients with burns. (N Engl J Med 299:915–919, 1978)