Once versus thrice daily gentamicin in patients with serious infections

Prins, Jan M.; Büller, Harry R.; Kuijper, Ed J.; Tange, R. A.; Speelman, Peter

doi:10.1016/0140-6736(93)90137-6

Cited by 327 publications

(192 citation statements)

References 30 publications

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“…In two recent publications, it was proposed that aminoglycoside dosages in patients receiving single daily doses should be reduced when the 24-h trough concentrations exceeded 2 mg/L (Parker & Davey, 1993;Prins et al, 1993). However, while a threshold concentration of this magnitude has been used routinely for multidose regimens, there is little evidence to suggest that it is equally appropriate for once-daily regimens.…”

Section: Introductionmentioning

confidence: 99%

Monitoring serum concentrations for once-daily netilmicin dosing regimens

Blaser

König

Simmen

et al. 1994

J Antimicrob Chemother

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A once-daily dosing regimen for aminoglycosides is less expensive, at least as effective and possibly less toxic than multiple-daily dosing regimens. Once-daily dosing might also allow the frequency of measuring the serum concentrations of these antibiotics to be reduced since two of the major objectives of monitoring, high peak and low trough concentrations, are more likely to be achieved with this regimen. A novel strategy for monitoring serum concentrations which relies on a single sample obtained 8 h after a dose, as opposed to both trough and peak samples, is evaluated here. Serum kinetics of netilmicin were studied prospecu'vely in 51 adult patients with initial serum creatinine concentrations of < 130 /imol/L who were treated with a median daily dosage of 400 mg. Concentrations measured 8 h after administration were within the target range of 1-5-6 mg/L in 113 of 134 dosing intervals studied. Concentrations above and below this range correlated significantly with higher and lower 24-h trough concentrations and areas under the curve respectively. There was also a significant correlation between 8-h netilmicin concentrations and nephrotoxicity (P < 0-05); a relative increase of ^ 25% in the serum creatinine concentration or an absolute increase of > 25 //mol/L was detected in 0 of 7 patients with an 8-h concentration of < 1-5 mg/L, in 3 of 33 patients (91%) with an 8-h concentration of 1-5-6 mg/L and in 4 of 11 patients (36%) with an 8-h concentration of > 6 mg/L. The results of this study suggest that adequate information about serum netilmicin concentrations in patients receiving a once-daily dose may be derived from a sample obtained 8 h after administration.

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Section: Introductionmentioning

confidence: 99%

Monitoring serum concentrations for once-daily netilmicin dosing regimens

Blaser

König

Simmen

et al. 1994

J Antimicrob Chemother

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“…The potential advantages of once-daily aminoglycoside dosing have received recent attention [1][2][3]. Therapeutic advantages over conventional dosing include a probable lower incidence of toxicity, and at least equal efficacy.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Using pharmacokinetic individualisation, Konrad et al [7] found that the average total daily dose of netilmicin in patients with normal renal function was 7.8 mg kg-" day-l and recommended a starting dose of once-daily therapy of 7.0 mg kg-' day-'. Retrospective A variety of authors have recommended or implied that trough concentrations of less than 2 mg 1-are acceptable when using once-daily dosing [3,7,10,11]. Others have said that 2 mg 1-1 is too high and have suggested an upper limit of 1 mg 1-1 for a 24 h trough concentration [9,12].…”

Section: Introductionmentioning

confidence: 99%

A suggested approach to once‐daily aminoglycoside dosing.

Begg

Barclay

Duffull

1995

Brit J Clinical Pharma

313

201

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1. Once‐daily aminoglycoside dosing has many advantages and has been widely advocated. However, existing guidelines for methods of administration and monitoring are non‐specific and may lead to excessive dosing. 2. The traditional approach of aiming for target peak and trough concentrations is not appropriate for once‐daily dosing. 3. A method is proposed which uses a target area under the concentration‐ time curve (AUC) for the aminoglycoside based on the 24 h AUC that would result with conventional dosing. This method requires measurement of two drug concentrations, one approximately 0.5 h after the end of the infusion and another at a later time (6‐22 h) depending on renal function. 4. A simpler, graphical method is also proposed for patients with normal renal function, which requires the measurement of a single concentration at a time between 6 and 14 h. 5. Both methods are likely to be safer than existing guidelines.

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“…Probenecid and trimethoprim are known inhibitors of tubular secretion, [237] and the observation that the AUC of AZT increased 80-115% when concomitantly used with probenecid can partly be explained by this effect (table III). [175][176][177] Aminoglycosides are nephrotoxic drugs [238] and the use of this class of drugs might lead to a decreased renal clearance, as demonstrated for DDC (table III). [24] 3.2 Pharmacodynamic Interactions…”

Section: Excretionmentioning

confidence: 99%