No abstract

in 4 (18 %) out of 22 patients. Though this did not cause symptoms it nevertheless emphasizes t;he need to avoid giving gentamicin for minor sepsis. But in life--threatening Gramnegative sepsis in hospital practice we believe gentamicin therapy is the treatment of choice. There is still a tendency to give inadequate doses of gentamicin because of excessive anxiety about its toxicity. Inadequately-treated serious Gramnegative sepsis has a high mortality. The presenit series shows that vigorous but closely monitored gentamicin therapy gives excellent results without significant toxicity.We therefore recommend t-hat peak serum concentrations should be measured from the first day of treatment and the dose modified accordingly until values of at least 5 ,ug/ml or preferably 8-12 ,ug/ml are achieved. Dosage should be reduced only if concentrations exceed 15 ,ug/ml. Further assays of peak concentrations should be made when the dosage is altered. Trough concentrations as well as peaks should also be measured when there is a change in renal function and at least twice weekly during prolonged therapy. Closer monitoring is necessary during renal dialysis or the oliguric/anuric phase of acute renal failure. The more important function of monitoring is to ensure that adequate peak serum concentrations are reached as soon as possible, provided ,there is no severe renal dysfunction.