Gentamicin toxicity has been shown to be related to high concentrations in serum. Because there is a narrow range between its therapeutic and toxic levels, serial monitoring of gentamicin is the most reliable method of guiding therapy. Microbiological assays commonly in use do not afford the desired speed and accuracy, and results may be difficult to interpret in the presence of other antimicrobials. Hence, a rapid, sensitive, and highly specific radioimmunoassay for measurement of gentamicin in serum has been developed. Antibody to gentamicin was raised in rabbits by using a gentamicin-albumin conjugate. Tritiated gentamicin (specific activity 1.0 Ci/mM) competes with unlabeled gentamicin for binding sites on the antibody. Dextran-coated charcoal separates the unbound from antibody-bound gentamicin. Serum levels of gentamicin are determined by comparison with a standard curve. This method can detect concentrations as low as 0.01 μg/ml. Results of a 24-tube run can be obtained in 1 h, thus allowing modification of gentamicin dosage to advantage.
Ranitidine, an H2-receptor antagonist, has been shown to reduce pentagastrin-stimulated gastric secretion. We examined the relationship between inhibition of gastric secretion and ranitidine serum concentration. Twelve normal male subjects received 20, 40, or 80 mg of ranitidine orally 90 min before starting a 3-hr continuous infusion of pentagastrin, 2 micrograms/kg/hr. Ranitidine, 20, 40, and 80 mg, reduced hydrogen ion output by 29%, 50%, and 70% and secretion volume by 21%, 37%, and 47%. Pepsin activity was reduced by 8%, 50%, and 49% by the same doses. Peak serum concentration was correlated positively with percent reduction in hydrogen ion output (r = 0.81, P less than 0.001) and volume (r = 0.71, P less than 0.01) over a 2-hr period. A 50% inhibition of hydrogen ion output was associated with a peak ranitidine serum concentration of 165 micrograms/l and subjects reached peak serum concentration 60 to 120 min after oral dosing. An appropriate therapeutic effect should be achieved with 8 hourly doses of 80 mg ranitidine. No clinically significant subjective or toxic biochemical effect of ranitidine was seen after single doses. White blood cell count was reduced in 11 of 12 subjects 7 days after ranitidine, an observation which calls for further investigation.
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