Pharmacy World and Science

, Volume 15, Issue 4, pp 151–155 | Cite as

Aminoglycoside monitoring in the once- or twice-daily era

  • R. Janknegt


The results of an inquiry among Dutch hospital pharmacists on the monitoring of aminoglycosides are presented and the relevance of monitoring is discussed. The vast majority of Dutch hospitals (47 out of 65) use aminoglycosides in a twice-daily dosage regimen, whereas 12 hospitals use a once-daily dose. The timing of peak level sampling is usually 30 min after the end of an intravenous infusion of 20–30 min. Mean ’therapeutic’ peak levels of gentamicin were 7–13 mg/l in the once-daily group, 6.4–9.6 mg/l in the twice-daily group and 5–9 mg/l in the small thricedaily group. Little or no evidence has been published to substantiate a real therapeutic range for aminoglycosides, concerning a relationship between peak or trough levels of aminoglycosides and clinical efficacy, ototoxicity and nephrotoxicity. All studies have been performed with the conventional thrice-daily regimen. No therapeutic range can be defined yet for once-daily or twice-daily aminoglycosides. The monitoring of aminoglycosides may be helpful to reduce the variability in serum levels after a standard dose.


Aminoglycosides Dose-response relationship, drug Ear/toxicity Kidney/toxicity Therapeutic drug monitoring 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    McCormack JP, Jewesson PJ. A critical reevaluation of the ’therapeutic range’ of aminoglycosides. Clin Infect Dis 1992;14:320–39.PubMedGoogle Scholar
  2. 2.
    Uges DRA. Referentiewaarden van klinisch farmaceutische en toxicologische bepalingen [Reference values for clinical-pharmaceutical and toxicological analysis]. In: De Smet PAGM, Van Loenen AC, Offerhaus L, Van der Does E, editors. Medicatiebegeleiding. Houten: Bohn Stafleu Van Loghum, 1990:421–48.Google Scholar
  3. 3.
    Banks BE. Monitoring of aminoglycosides. J Antimicrob Chemother 1990;26:145–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Edwards C, Bint AJ, Venables CW, Scott DK. Sampling time for serum gentamicin levels. J Antimicrob Chemother 1992;29:575–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Jelliffe RW, Iglesias T, Hurst AK, Foo KA, Rodriguez J. Individualising gentamicin dosing regimens. Clin Pharmacokinet 1991;21:461–78.PubMedCrossRefGoogle Scholar
  6. 6.
    Gilbert DN. Once-daily aminoglycoside therapy. Antimicrob Agents Chemother 1991;35:399–405.PubMedGoogle Scholar
  7. 7.
    De Vries PJ, Verkooyen RP, Leguit P, Verbrugh HA. Prospective randomized study of once-daily versus thrice-daily netilmicin regimens in patients with intraabdominal infections. Eur J Clin Microbiol Infect Dis 1990;9:161–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Marik PE, Lipman J, Kabilsky S, Scibante J. A prospective randomized study comparing once-versus twice-daily amikacin dosing in critically ill adult and paediatric patients. J Antimicrob Chemother 1991;28:753–64.PubMedCrossRefGoogle Scholar
  9. 9.
    Nordstroem L, Rinberg H, Cronberg S, Thernstroem O, Walder M. Does administration of an aminoglycoside in a single daily dose affect its efficacy and toxicity? J Antimicrob Chemother 1990;25:159–73.CrossRefGoogle Scholar
  10. 10.
    Janknegt R. Aminoglycoside therapy. Current use and future prospects. Pharm Weekbl [Sci] 1990;12:81–90.Google Scholar
  11. 11.
    Alvarez JS, Sacristian JA, Alsar MJ. Aminoglycosides: determination of new therapeutic ranges. Drug Intell Clin Pharm 1991;25:558.Google Scholar
  12. 12.
    Bakker-Woudenberg IA, Roosendaal R. Impact of dosagregimens on the efficacy of antibiotics in the immunocompromised host. J Antimicrob Chemother 1988;21:145–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Zhanel GG, Hoban DJ, Harding GKM. The postantibiotic effect: a review ofin-vitro andin-vivo data. Drug Intell Clin Pharm 1991;25:155–63.Google Scholar
  14. 14.
    Rodvold KA, Zakufa H, Rotschafer JC. Aminoglycoside pharmacokinetic monitoring: an integral part of patient care? Clin Pharm 1988;7:608–13.PubMedGoogle Scholar
  15. 15.
    Garrison MW, Zaske DE, Rotschafer JC. Aminoglycosides: another perspective. Drug Intell Clin Pharm 1990;24:267–72.Google Scholar
  16. 16.
    Ter Braak EWMT, De Vries PJ, Verbrugh HA. Aminoglycosiden eenmaal daags: krachtig maar kort [Aminoglycosides once-daily, powerful but short]. Ned Tijdschr Geneeskd 1992;136:1745–9.PubMedGoogle Scholar
  17. 17.
    Pancoast SJ. Aminoglycoside antibiotics in clinical use. Med Clin North Am 1988;72:581–612.PubMedGoogle Scholar
  18. 18.
    Moore RD, Lietman PS, Smith CR. Clinical response to aminoglycoside therapy: importance of the ratio of peak concentrations to MIC. J Infect Dis 1987;155:93–9.PubMedGoogle Scholar

Copyright information

© Periodicals Service Company 1993

Authors and Affiliations

  • R. Janknegt
    • 1
  1. 1.Department of Clinical Pharmacy and ToxicologyMaasland Hospital SittardMB SittardThe Netherlands

Personalised recommendations