AMINOGLYCOSIDE MONITORING IN THE ONCE-DAILY OR TWICE-DAILY ERA - THE DUTCH SITUATION CONSIDERED

The results of an inquiry among Dutch hospital pharmacists on the moni toring of aminoglycosides are presented and the relevance of monitorin g is discussed. The vast majority of Dutch hospitals (47 out of 65) us e aminoglycosides in a twice-daily dosage regimen, whereas 12 hospital s use a once-daily dose. The timing of peak level sampling is usually 30 min after the end of an intravenous infusion of 20-30 min. Mean 'th erapeutic' peak levels of gentamicin were 7-13 mg/l in the once-daily group, 6.4-9.6 mg/l in the twice-daily group and 5-9 mg/l in the small thrice-daily group. Little or no evidence has been published to subst antiate a real therapeutic range for aminoglycosides, concerning a rel ationship between peak or trough levels of aminoglycosides and clinica l efficacy, ototoxicity and nephrotoxicity. All studies have been perf ormed with the conventional thrice-daily regimen. No therapeutic range can be defined yet for once-daily or twice-daily aminoglycosides. The monitoring of aminoglycosides may be helpful to reduce the variabilit y in serum levels after a standard dose.