Amikacin, an aminoglycoside with renal excretion, is used for infections caused by resistant pathogens, but its use is related to the risk of nephrotoxicity. The hospital pharmacist can optimize its use, minimizing this adverse event. The present study evaluated the impact of pharmaceutical intervention in the prevention of nephrotoxicity associated with amikacin, comparing outcomes before and after daily pharmaceutical follow-up in a tertiary hospital in southern Brazil.

A “before and after” study was conducted through an institutional database, with an anonymized query request. Data from patients over 18 years old who used amikacin for ≥ 5 days during hospitalization were analyzed for the periods January/2019 to July/2021 (Period 1) and September/2021 to February/2024 (Period 2). The daily pharmaceutical intervention, implemented in August/2021, consisted of signaling to the prescriber dosage adjustments of amikacin when these were necessary. Descriptive statistical analysis of dose and acute kidney injury (RIFLE) data was performed with SPSS 18.0, considering p ≤ 0.05.

A total of 698 patients were analyzed (349 per period), with similar demographic characteristics. There were no significant differences between periods for sex (p = 0.759), race (p = 0.703), length of stay (P1: 24.5 days; P2: 22.0 days), duration of treatment with amikacin (P1: 8.5 days; P2: 7.0 days), or clinical outcomes (discharge: P1: 78.3% vs P2: 82.5%; death: P1: 21.7% vs P2: 17.5%; p = 0.171). However, Period 2 showed greater dose adjustment adequacy for amikacin (p < 0.001) over 14 days (e.g., D0: 58 P2 vs 38 P1; D13: 7 P2 vs 2 P1). This optimization correlated with superior renal protection in Period 2 (p = 0.001), with more patients without AKI (296 P2 vs 138 P1) and lower incidence of RIFLE categories of risk (45 P2 vs 183 P1), injury (0 P2 vs 13 P1), and failure (0 P2 vs 6 P1).

The work of the clinical pharmacist, as part of a multidisciplinary strategy, may contribute to more appropriate therapy with the antimicrobial amikacin and to a considerable reduction in patients at risk of acute kidney injury, injury, and renal failure.