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[Effectiveness and adverse effects of a single daily dose of gentamicin versus twice daily administration]
1Klinika za unutrasnje bolesti Medicinskog fakulteta u Zagrebu i Klinickog bolnickog centra, Zagreb.
Abstract:
The efficacy and toxicity of a single versus double gentamicin dose were compared. Fifty-four ill patients with infection susceptible to gentamicin in Department of Internal Medicine, University Hospital Rebro, Zagreb, were included in this study. The following criteria excluded patients from the study: serious renal failure (creatinine > 250 mumol/l), hearing impairment, condition and immunodeficiency. Patients were randomised to receive either gentamicin 4 mg/kg by infusion over a 30 minute period once daily, a single-dose group (SG) (N = 25), or gentamicin 2 mg/kg intravenously twice daily, a double-dose group (DG) (N = 29). Almost all patients in a single-dose group achieved peak therapeutic concentrations, while trough gentamicin concentrations were below the recommended. In a double-dose group, only 70.5% of the patients obtained peak concentrations, and 7.5% of the patients had inadequately high trough gentamicin concentrations. In a single-dose group, there were no changes in serum creatinine values, while in a double-dose group there was a significant increase in serum creatinine concentration and a decrease in serum creatinine clearance. Risk factors for gentamicin nephrotoxicity were: through gentamicin concentration, older age and initial abnormal renal function. Ototoxic reaction developed in 35% of the patients on a single gentamicin dose and in 44.8% of the patients on a double dose (P > 0.05), and a lesion was more diffuse in this group. Risk factors for gentamicin ototoxicity were: through gentamicin concentration, duration of therapy, older age and abnormal renal function. Therapeutic effect was observed in 96% of the patients in SG and in 86.2% of the patients in DG (P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
A single daily dose of gentamicin achieved higher therapeutic concentrations and better outcomes with fewer adverse effects than a double daily dose in patients with susceptible infections.
Area of Science:
- Pharmacology
- Nephrology
- Ototoxicology
Background:
- Gentamicin is a widely used antibiotic for treating serious bacterial infections.
- Optimizing gentamicin dosing is crucial to maximize efficacy while minimizing toxicity.
- Previous studies have yielded conflicting results regarding single versus multiple daily dosing strategies.
Purpose of the Study:
- To compare the efficacy and toxicity of a single daily dose versus a double daily dose of gentamicin.
- To identify risk factors for gentamicin-induced nephrotoxicity and ototoxicity.
Main Methods:
- A randomized study involving 54 patients with gentamicin-susceptible infections.
- Patients received either a single daily dose (4 mg/kg) or a double daily dose (2 mg/kg twice daily) of gentamicin.
- Serum creatinine, creatinine clearance, and gentamicin peak/trough concentrations were monitored. Ototoxicity was assessed clinically.
Main Results:
- The single-dose group (SG) achieved therapeutic peak gentamicin concentrations more consistently than the double-dose group (DG).
- DG showed a significant increase in serum creatinine and decrease in creatinine clearance, indicating nephrotoxicity.
- Ototoxicity occurred in 35% of SG patients and 44.8% of DG patients, with more diffuse lesions in DG.
Conclusions:
- Single daily gentamicin dosing is more effective and safer, with lower nephrotoxicity and comparable ototoxicity, than twice-daily dosing.
- High trough gentamicin concentrations, older age, and pre-existing renal impairment are risk factors for both nephrotoxicity and ototoxicity.