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Once-daily gentamicin: translating theory into practice
1Public Health Laboratory, University Hospital, Queen's Medical Centre, Nottingham, UK.
Abstract:
Gentamicin continues to have an important role in the treatment of serious bacterial infections. There is increasing interest in once-daily administration, which is more convenient than multiple-dose regimens. Animals studies and clinical trials suggest that once-daily administration is as efficacious and no more toxic for a variety of infections, but there is still some reluctance to use once-daily regimens routinely in neutropenic patients, because of the potential risk of breakthrough bacteraemia. A number of aspects of the serum concentration monitoring of once-daily gentamicin remain unresolved. The most commonly used assay systems are not sensitive enough, without some modification in technique, to detect the very small pre-dose concentrations seen with once-daily dosing, and it is not clear what constitutes an acceptable pre-dose concentration. Until the results from further studies become available, it is prudent to maintain a pre-dose concentration below 1 mg.1(-1), and local arrangements are necessary to address the frequency and timing of assays. It seems likely that once-daily administration will become the norm, because of its many advantages.
Insights
Once-daily gentamicin dosing is effective and safe for serious bacterial infections. Monitoring pre-dose concentrations below 1 mg/L is recommended until further studies clarify optimal levels for neutropenic patients.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Gentamicin remains crucial for treating severe bacterial infections.
- Once-daily administration offers convenience over multiple daily doses.
- Clinical data support the efficacy and safety of once-daily gentamicin for various infections.
Purpose of the Study:
- To evaluate the current understanding and unresolved issues regarding once-daily gentamicin administration.
- To address concerns about serum concentration monitoring in once-daily dosing regimens.
- To provide guidance on pre-dose concentration targets for once-daily gentamicin therapy.
Main Methods:
- Review of animal studies and clinical trials on once-daily gentamicin.
- Analysis of challenges in therapeutic drug monitoring (TDM) for once-daily dosing.
- Discussion of current recommendations and areas needing further research.
Main Results:
- Once-daily gentamicin is as effective and safe as multiple daily doses for many infections.
- Assay systems often lack sensitivity for low pre-dose concentrations in once-daily regimens.
- An acceptable pre-dose concentration target is not definitively established, with <1 mg/L suggested as prudent.
Conclusions:
- Once-daily gentamicin administration is likely to become standard practice due to its advantages.
- Further research is needed to refine serum concentration monitoring for once-daily gentamicin.
- Careful consideration of assay methods and pre-dose targets is necessary, especially for neutropenic patients.