PharmPK Discussion - Pulse dosing of aminoglycosides

• On 8 May 1996 at 10:40:53, anaizi (nanaizi.at.frontiernet.net) sent the message
  

  
  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
  preferred.
  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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• On 12 May 1996 at 14:10:09, Carl Heisel (cheisel.-at-.teleport.com) sent the message
  

  
  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.
  
  Thanks.
  
  

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Copyright 1995-2014 David W. A. Bourne (david@boomer.org)