ONCE-DAILY GENTAMICIN - TRANSLATING THEORY INTO PRACTICE

Gentamicin continues to have an important role in the treatment of ser ious bacterial infections. There is increasing interest in once-daily administration, which is more convenient than multiple-dose regimens. Animal studies and clinical trials suggest that once-daily administrat ion is as efficacious and no more toxic for a variety of infections, b ut there is still some reluctance to use once-daily regimens routinely in neutropenic patients, because of the potential risk of breakthroug h bacteraemia. A number of aspects of the serum concentration monitori ng of once-daily gentamicin remain unresolved. The most commonly used assay systems are not sensitive enough, without some modification in t echnique, to detect the very small pre-dose concentrations seen with o nce-daily dosing, and it is not clear what constitutes an acceptable p re-dose concentration. Until the results from further studies become a vailable, it is prudent to maintain a pre-dose concentration below 1 m g . 1(-1), and local arrangements are necessary to address the frequen cy and timing of assays. It seems likely that once-daily administratio n will become the norm, because of its many advantages.