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Journal of Antimicrobial Chemotherapy, Vol 39, 677-686, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy

REVIEW, TUTORIAL

Once-daily dosing of aminoglycosides: review and recommendations for clinical practice

CD Freeman, DP Nicolau, PP Belliveau and CH Nightingale
Department of Medicine, University of Missouri-Kansas City School of Medicine, 64108, USA. cfreeman@cctr.umkc.edu

The use of higher-dose, extended interval (i.e., once-daily) aminoglycoside regimens to optimize bacterial killing is justified by a pharmacodynamic principle of aminoglycosides, namely concentration- dependent killing, and by the partial attribution of the toxicity of aminoglycosides to prolonged serum concentrations. Numerous in-vitro and animal studies have supported using once-daily aminoglycoside dosing. Clinical studies show at least equal effectiveness and no greater toxicity when compared with traditional regimens. A dose of 5-7 mg/kg of gentamicin, tobramycin, or netilmicin, with at least a 24 h dosing interval should be employed and a similar regimen can be applied to amikacin dosing. As yet, there are some patient populations that have not been adequately studied to determine whether or not once-daily aminoglycoside dosing would be a better choice than traditional dosing regimens.
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