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Extended dosage intervals for aminoglycosides
D P Rodman1, A J Maxwell, J T McKnight
1Department of Clinical Pharmacy Practice, School of Pharmacy, Auburn University, AL.
American Journal of Hospital Pharmacy
|August 15, 1994
Summary
Extended aminoglycoside dosing intervals are effective and may reduce toxicity. Once-daily administration leverages the postantibiotic effect (PAE) for potent bacterial killing while potentially lowering nephrotoxicity and ototoxicity risks.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Aminoglycosides are potent antibiotics with a short elimination half-life.
- Concerns exist regarding aminoglycoside nephrotoxicity and ototoxicity with traditional dosing.
Purpose of the Study:
- To discuss the rationale and effectiveness of extended dosage intervals for aminoglycosides.
- To evaluate the impact of once-daily aminoglycoside administration on efficacy and toxicity.
Main Methods:
- Review of the postantibiotic effect (PAE) of aminoglycosides.
- Analysis of clinical trials comparing once-daily versus traditional aminoglycoside dosing regimens.
- Examination of aminoglycoside pharmacokinetics and toxicity mechanisms.
Main Results:
- Aminoglycosides exhibit a prolonged PAE against various pathogens, supporting extended dosing.
- Higher transient serum concentrations with once-daily dosing may reduce nephrotoxicity and ototoxicity.
- Clinical trials suggest once-daily aminoglycoside administration is as effective as traditional regimens for gram-negative infections.
- Once-daily dosing may decrease the frequency or delay the onset of aminoglycoside-related toxicities.
Conclusions:
- Once-daily aminoglycoside administration is a viable and potentially safer alternative to traditional dosing.
- Extended dosing intervals leverage the PAE and may mitigate toxicity risks in patients with normal renal function, renal dysfunction, or neutropenia.
- Further research is warranted, but current evidence supports the efficacy and safety of once-daily aminoglycoside regimens.