DEVELOPMENT OF GUIDELINES FOR GENTAMICIN DOSING

The performance of dosage guidelines for starting gentamicin therapy w as evaluated prospectively in 50 patients with suspected or proven Gra m-negative septicaemia and the results were compared with results from similar group of 50 patients for whom the guidelines were not followe d. Peak concentrations were significantly higher when the guidelines w ere followed (7.2 (+/- 1.9) mg/L vs 5.7 (+/- 1.8) mg/L) but there was no difference in trough concentrations. Fifty-eight per cent of patien ts had both peak and trough concentrations within the target range (pe ak > 5 mg/L, trough < 2 mg/L) when doses were decided empirically; thi s increased to 96% when the guidelines were followed. However, use of the guidelines achieved peaks of > 7 mg/L in only 56% of patients. A r evised protocol with higher doses given less frequently was therefore developed and a prospective assessment of its performance indicated th at satisfactory concentrations were obtained in 96% of patients.