Improving gentamicin dosing: A suggested approach to a simplified once-daily dosing schedule

摘要

Traditionally, gentamicin has been administered at a dosage of 3-5mg/kg daily in divided doses, typically every 8 h. However, therapeutic drug monitoring has shown that multiple daily dosing rarely achieves adequate peaks and often produces high trough levels [1]. During the last two decades, there has been a move toward single daily dosing. Randomized controlled trials have indicated that once-daily aminoglycoside administration is as efficacious as the traditional multiple-dose method; may lower, but not eliminate, the risk of drug-induced nephrotoxicity and ototoxicity; and is simpler, less time-consuming and more cost-effective than multiple-dose regimens [2-4]. The aims of once-daily dosing are as follows: (1) to achieve high peak serum levels [10 times the minimum inhibitory concentration (MIC)] for maximum bacterial kill, as efficacy relates to the ratio by which post-dose levels exceed MIC; and (2) to achieve a short period of low drug concentration to minimize toxicity (approximately 4h).