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Concerning the current trends in the dosing of aminoglycoside antibiotics
(AGAs) consider the following:
1. Pulse dosing of AGAs means high doses (5-7 mg/Kg) with long dosing
intervals (usually once every 24 to 48 hrs, depending the drug's half-life).
2. After a peak of 10 - 20 mg/L, the serum AGA level should ideally drop to
undetectable (<0.3 mg/L) several hours before the next dose is due.
3. The higher peaks should enhance the antimicrobial efficacy; AGAs have
concentration-dependent kill rate. Although there are no controlled clinical
studies that show higher therapeutic efficacy with pulse dosing compared to
the traditional multiple daily dosing regimen, the available data indicate
that pulse dosing is at least as effective as the traditional method.
4. Pulse dosing may be safer; lower nephrotoxicity was demonstrated in at
least one clinical study (Prins et al. Lancet 1993; 341: 335-339). Our own
experience at the University of Rochester Medical Center tends to support
the same conclusion.
5. AGAs have the so-called post-antibiotic effect (PAE) (continued
suppression of bacterial growth even after the drug level has fallen below
the MIC). The duration of the PAE depends on the organism and on the
preceding peak (within limits, higher peaks give longer PAEs).
6. In general, for antimicrobial agents that have concentration dependent
bactericidal action and a PAE, higher single doses with longer intervals are
7. For more information please e-mail me at nanaizi.at.frontiernet.net
You will find many references in the following:
1. Am J Hosp Pharm 1994; 51:2016-2021
2. Pharmacotherapy 1995; 15:297-316
Dr. Anaizi, PhD RPh
Associate Prof of Pharmacology and Physiology
Univ. of Rochester (NY)
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We are currently dosing aminoglycosides qd per protocol which is an
amalgamation of Gilbert's method and Quintalani's.
We routinely measure levels 12h after the first dose. This occasionally
yields useful information. Just this week we had a 15 yo patient with
severe abdominal trauma and liver injuries. The 12h level was
unexpectedly elevated. We were able to modify the dose prior to seeing
an increase in SCr.
Does anyone have information in qd dosing in pediatrics? We are hesitant
to use it in younger chiledren and infants.
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