Practicalities of once-daily aminoglycoside dosing

Parker, Sharon E.; Davey, Peter

doi:10.1093/jac/31.1.4

Cited by 61 publications

(26 citation statements)

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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%

“…Therapeutic advantages over conventional dosing include a probable lower incidence of toxicity, and at least equal efficacy. Practical advantages include straightforward dosage calculation, guaranteed high peak serum concentrations, decreased personnel time, fewer assays for therapeutic monitoring and lower consumable costs [1].…”

Section: Patient Selectionmentioning

confidence: 99%

“…Many believe the time has come for the introduction of once-daily dosing into clinical practice, at least for some patient groups [1,2]. Unfortunately no one has described exactly how this should be done and the adoption of the loose guidelines that have been offered may lead to excessive dosing in some patients.…”

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%

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A suggested approach to once‐daily aminoglycoside dosing.

Begg

Barclay

Duffull

1995

Brit J Clinical Pharma

314

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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Section: Patient Selectionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A suggested approach to once‐daily aminoglycoside dosing.

Begg

Barclay

Duffull

1995

Brit J Clinical Pharma

314

201

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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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Single Daily Dosing of Aminoglycosides

Preston,

Briceland

1995

Pharmacotherapy

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To evaluate the rationale behind dosing aminoglycosides as a single daily dose versus traditional dosing approaches, we conducted a MEDLINE search to identify all pertinent articles, and also reviewed the references of all articles. Single daily dosing of aminoglycosides is not a new concept, having been examined since 1974. The advantages of this regimen include optimum concentration‐dependent bactericidal activity, longer dosing intervals due to the postantibiotic effect (PAE), and prevention of bacterial adaptive resistance. Because of longer dosing intervals, toxicity may also be delayed or reduced. Costs may be reduced due to decreased monitoring and administration. Clinically, the regimen has been implemented in various patient populations with reported success. Questions remain, however, about optimum dose, peak and trough serum concentrations, and dose adjustment in patients with renal impairment or neutropenia. More clinical experience with this method in large numbers of patients has to be published. Pharmacists can be instrumental in monitoring patients receiving once‐daily therapy and by educating health care professionals as to the rationale behind the therapy.

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Practicalities of once-daily aminoglycoside dosing

Cited by 61 publications

References 0 publications

A suggested approach to once‐daily aminoglycoside dosing.

A suggested approach to once‐daily aminoglycoside dosing.

Monitoring serum concentrations for once-daily netilmicin dosing regimens

Single Daily Dosing of Aminoglycosides

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