Minimizing aminoglycoside toxicity by prescriber notification of prolonged therapy

The development of aminoglycoside toxicity has been reported related to duration of exposure. To potentially reduce the duration of exposure to aminoglycosides, pharmacists documented, via a permanent note in the patient health record, the exposure and potential associated risks of any patient who received greater than 10 consecutive days or 20 days total within 3 months of aminoglycoside therapy at this institution. The impact of the notification on further aminoglycoside exposure was evaluated over two 6-month periods. Notification was successful in ending further aminoglycoside exposure in 25 of 57 patients. Continued aminoglycoside therapy primarily involved treatment of febrile neutropenia and endocarditis. Prevention of toxicity was suggested in the second evaluation period in which none of the patients, having therapy altered by the notification, developed toxicity versus 13 of the 40 other patients who developed a rise in serum creatinine concentration or a reduction in hearing acuity. The methodology that produced these positive results should be easily transferable to other institutions.