The aminoglycoside panel: a new approach to monitoring aminoglycoside therapy

The aminoglycoside antibiotics gentamicin and tobramycin have been monitored traditionally by measuring peak and trough drug levels in serum. We found interpretation of these data to be hazardous, due to variations in the drug administration-specimen collection process and routine medical events and practices. We describe an aminoglycoside panel consisting of three serum levels drawn across one dosage interval. Gentamicin and tobramycin were measured by an enzyme immunoassay. 430 panels (1,290 samples) were evaluated by determining each panel's conformity to a classical monoexponential decay curve. Panels were then categorized by pattern of fit to this model. Sixty-two percent of the panels fell within acceptable limits of the model, while 13% displayed obvious errors. The percentage of acceptable panels on nursing units given an intensive educational program on the proper protocol for drug administration-specimen collection procedures was increased compared with the rest of the hospital. We propose the adoption of the aminoglycoside panel for the routine monitoring of these antibiotics as a means of gauging specimen and data quality.