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At 08:17 PM 5/6/96 +0100, you wrote:
>Status:
>
>I am a hospital pharmacist, and recently we have been receiving orders
>for high doses of aminoglycosides to be used once daily. Both gentimicin
>and tobramycin. Doses range from 250mg to 300 mg given once daily.
>
>I have just recently joined this discussion group.
>
>Name: Doyle Wilkinson, R. Ph.
>Hospital: Doctor's Regional
>
>mdwilk827.-a-.worldnet.att.net
>
Doyle:
I was at the National Pediatric Infectious Disease Conference last
month in New Orleans, LA, and mention was made of once a day dosing of
aminoglycosides. Docs there expect to see this in their hospital in the
near future. There is also literature around verifing the use on once daily
dosing. It seems the logic behind all of this is that a high peak is not
the problem with aminoglycosides, its the sustained trough. I don't have
the literature references at home but I will get what I can and post it to
the group. There have been several questions on medical list concerning
this lately with no good reply that I have seen. I don't presume to offer
the perfect or even best response. I only hope to stimulate a little
conversation and learn something in the process.
Thanks,
Robert Aucoin RPh
Peds Clinical Pharmacist
Baton Rouge, LA
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At 11:18 AM 5/7/96 -0500, you wrote:
>PharmPK - Discussions about Pharmacokinetics, Pharmacodynamics and related
>topics
>At 08:17 PM 5/6/96 +0100, you wrote:
>>Status:
>>
>>I am a hospital pharmacist, and recently we have been receiving orders
>>for high doses of aminoglycosides to be used once daily. Both gentimicin
>>and tobramycin. Doses range from 250mg to 300 mg given once daily.
>>
>>I have just recently joined this discussion group.
>>
>>Name: Doyle Wilkinson, R. Ph.
>>Hospital: Doctor's Regional
>>
>>mdwilk827.-a-.worldnet.att.net
We do this routinely at my institution and it is a popular topic when I do
CE programs. For a recent article, look for a meta-analysis by Michael
Barza in a recent issue of Lancet (I'm pretty sure it was within the last
month or so). Their conclusion was that "...[once-daily] aminoglycosides in
patients without pre-existing renal impairment is as effective as muliple
daily dosing, has alower risk of nephrotoxicity, and no greater risk of
ototoxicity. Given the additional convenience and reduced cost, once daily
dosing should be the preferred mode of administration."
Gary D. Theilman, Pharm.D.
Assistant Professor
Dept of Clinical Pharmacy Practice
School of Pharmacy, University of Mississippi
http://fiona.umsmed.edu/~theilman
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