EASIER MONITORING OF AMINOGLYCOSIDE THERAPY WITH ONCE-DAILY DOSING SCHEDULES

Little has been reported on serum levels attained using once-daily ami noglycoside regimens and their relation to dosage administered and ren al function. Consecutive patients with serious infections were randomi zed to receive gentamicin 4 mg/kg q 24 h i.v. (n = 69), gentamicin 1.3 3 mg/kg q 8 h i.v. (n = 46) or netilmicin 5.5 mg/kg q 24 h i.v. (n = 5 9) (with dose reduction in case of renal dysfunction). In the three gr oups, median first serum trough levels were 0.4, 1.0 and 0.4 mg/l, res pectively, and median first serum peak levels were 9.5, 4.7 and 12.2 m g/l (p < 0.01 once-daily vs. thrice-daily regimens). Dose adjustment b ecause of first trough concentrations of > 2 mg/l and/or peak concentr ations of < 6 mg/l was required in 6 %, 78 % and 12 % of patients, res pectively. Second trough and peak concentrations were significantly hi gher in the thrice-daily gentamicin group; serum levels remained const ant in the other two groups. The six patients in the once-daily groups who developed elevated trough levels later in therapy were characteri zed in most cases by a decline in renal function.