Basis for an adequate dosage of aminoglycoside antibiotics

Findings in clinical and microbiological investigations indicate that aminoglycoside therapy should be monitored by means of serum concentration assays for the following three reasons: 1) In vitro and in vivo studies indicate a quantitative relationship between aminoglycoside blood concentrations and clinical efficacy. 2) In contrast, attained serum concentrations correlate only poorly with the administered dose. 3) Nephrotoxicity and ototoxicity appear to be correlated with the area under the serum concentration time curve. Each of these arguments is illustrated with microbiological, pharmacokinetic or clinical studies. Presently available computer-based dosage recommendations inadequately take into account the individual variability of the patient.