Simplified monitoring of aminoglycosides

For many years it has been standard practice to give aminoglycosides in divided daily doses monitored by serum aminoglycoside assays. Recent experience indicates that aminoglycosides can be given as a single daily dose with equal or better efficacy and equal or less toxicity. The single-daily dose regimen is both cheaper and more convenient. Recommended serum aminoglycoside concentrations immediately before the next dose, or 8 h later, vary according to whether a single daily dose or divided dose schedule is used. This is seldom realized in practice. Estimated creatinine clearance enables better prediction of the daily dose than was formerly recognized, and is to be preferred. Earlier fears of giving aminoglycosides as a bolus intravenous injection have not been substantiated. After more than 40 years of use, we are beginning to learn how to monitor these potentially toxic drugs.