الفهرس 
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Abstract
Systemic inflammatory response syndrome (SIRS) refers to the consequences of a dysregulated host inflammatory response. It is clinically recognized by the presence of two or more of the following: temperature >38.5ºC or <35ºC, heart rate >90 beat/min, respiratory rate >20 breath/min or PaCO2 <32 mmHg, WBC >12,000 cells/mm3 or <4000 cells/mm3, or >10 percent immature (band) forms.
Sepsis: In sepsis, the clinical signs that define SIRS are present and are due to either a culture-proven infection or an infection identified by visual inspection.
Severe sepsis: severe sepsis exists if there is sepsis plus at least one of the signs of organ hypoperfusion or dysfunction.
Early goal-directed therapy: Resuscitation of the circulation in patients with severe sepsis should target a ScvO2 or SvO2 ≥70 percent, central venous pressure 8 to 12 mmHg, a mean arterial pressure (MAP) ≥65 mmHg and a urine output ≥0.5 mL/kg per hour.
Septic shock: Septic shock exists if there is severe sepsis plus one or both of the following:
• Systemic mean blood pressure is <60 mmHg (or <80 mmHg if the patient has baseline hypertension) despite adequate fluid resuscitation.
• Maintaining the systemic mean blood pressure >60 mmHg (or >80 mmHg if the patient has baseline hypertension) requires dopamine >5 mcg/kg per min, norepinephrine <0.25 mcg/kg per min, or epinephrine <0.25 mcg/kg per min despite adequate fluid resuscitation.
Adequate fluid resuscitation is defined as infusion of 20 to 30 mL/kg of saline solution, or a measured pulmonary capillary wedge pressure (PCWP) of 12 to 20 mmHg. Septic shock is one type of vasodilatory or distributive shock. It results from a marked reduction in systemic vascular resistance, often associated with an increase in cardiac output
The aim of this work was to study the efficacy and safety of using higher than standard dose of amikacin in patients with severe sepsis septic shock using ratio between peak level of amikacin to minimal inhibitory concentration of amikacin to the isolated pathogen.
The study was carried out on 64 adult patient of both sex, who fulfilled the criteria of severe sepsis and were admitted to the units of the Critical Care medicine Department in Alexandria Main University Hospital.
High dose of amikacin was defined as intravenous infusion of 30mg per kg amikacin.
The patients were classified according to peak amikacin level into two groups:
Responder: who were defined as an increase in their ratio of peak level divided on MIC 8.
Non responder: who were defined as a decrease in their ratio of peak level divided on MIC <8.