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Aminoglycoside dosing: one, two or three times a day?
A J McLean1, L L Ioannides-Demos, W J Spicer
1Alfred Group of Hospitals, Melbourne, VIC.
The Medical Journal of Australia
|January 1, 1996
Summary
Aminoglycoside dosing requires careful consideration of renal clearance. Modified once-daily dosing, tailored to individual renal clearance, prevents toxicity and maintains efficacy, unlike standard once-daily regimens.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Conventional aminoglycoside dosing regimens are established but may not be optimal.
- Higher doses at longer intervals (once-daily) are proposed for improved efficacy.
- Clinical outcomes and safety of once-daily aminoglycoside dosing are not fully established.
Purpose of the Study:
- To evaluate the safety and efficacy of modified once-daily aminoglycoside dosing.
- To assess the impact of renal clearance on aminoglycoside dosing strategies.
- To determine optimal dosing intervals to avoid toxicity and resistance.
Main Methods:
- Review of clinical trials on aminoglycoside dosing.
- Analysis of pharmacokinetic principles related to renal clearance.
- Comparison of conventional, literal once-daily, and modified once-daily dosing.
Main Results:
- Few trials show improved clinical outcomes with standard once-daily aminoglycoside dosing.
- Allowing trough levels below minimum inhibitory concentration has unknown clinical safety.
- Literal once-daily dosing poses risks of toxicity (reduced clearance) or resistance (increased clearance).
Conclusions:
- Modified once-daily aminoglycoside dosing, adjusted for individual renal clearance, is recommended.
- This approach avoids subtherapeutic trough levels, preventing toxicity and antibiotic resistance.
- Individualized dosing ensures both safety and efficacy of aminoglycoside therapy.