ONCE-DAILY AMINOGLYCOSIDES - PRACTICAL GUIDELINES

There is ample evidence that once-daily dosing of aminoglycosides is p referable to the conventional regimens during the treatment of serious infections. Experimental and clinical studies also provide evidence t hat this regimen can be safely used in children, neutropenic patients and endocarditis. The use of once-daily tobramycin in cystic fibrosis merits further study, as the pharmacokinetics of the aminoglycosides a re altered in these patients. The dose-adjustment strategy in patients with renal failure is still controversial, but reducing the daily dos e whilst maintaining the q24-h interval has been demonstrated to be sa fe. Although the value of serum level monitoring in ensuring efficacy and avoiding toxicity has been overestimated in the past, especially i n patients with renal failure, an undesirable accumulation of the amin oglycosides can occur. The best way to detect accumulation remains to be defined. (C) 1998 Elsevier Science B.V.