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Aminoglycoside dosing considerations in intensive care unit patients
1Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA.
Objective:
Factors affecting aminoglycoside dosing requirements in critically ill adult patients were reviewed.
Data Sources:
A literature search was performed from 1979 to 1992 and articles pertaining to aminoglycoside dosing were obtained.
Study Selection:
Only studies appearing in peer-reviewed journals were selected. Topics selected included: bactericidal kill kinetics, once-daily dosing regimens, critical illness, toxicity, aminoglycosides, intensive care unit, and lung penetration.
Conclusions:
Studies suggest that larger initial aminoglycoside doses are necessary in critically ill patients (tobramycin/gentamicin 3 mg/kg or amikacin 9 mg/kg) to achieve adequate peak serum concentrations. Current studies have not shown an increase in the incidence of aminoglycoside toxicity when using these larger initial doses. Follow-up monitoring is dependent upon the patient's physiology and risk factors for aminoglycoside-induced toxicity.