Aminoglycosides once daily?

Six aminoglycosides (amikacin, gentamicin, kanamycin, netilmicin, streptomycin and tobramycin) are licensed for parenteral use in the UK. As a group, they remain effective against infections caused by aerobic gram-negative organisms and Staphylococcus aureus, including species commonly resistant to beta-lactam antibiotics. However, their use is limited by the severity of their unwanted effects and by their route and frequency of administration; traditionally, they have been given intravenously two to four times daily. Increasingly, they are being given once daily in an attempt to simplify treatment without reducing efficacy or increasing toxicity. Here we evaluate the advantages and disadvantages of this once-daily approach.