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There was an article in Journal of Antimicrobial Chemotherapy (1997) 39, 677-686 titled "Once-daily dosing of aminoglycosides: review and recommendations for clinical practice." This covers the ins and outs of it all pretty well, and has an extensive list of references for further info.
Quoting from the abstract: "The use of higher-dose, extended interval (i.e. once-daily) aminoglycoside regimens to optimize bacterial killing is justified by a pharmacodynamic principle of aminoglycosides, namely concentration-dependent killing, and by the partial attribution of the toxicity of aminoglycosides to prolonged serum concentrations. Clinical studies show at least equal effectiveness and no greater toxicity when compared with traditional regimens. A dose of 5-7 mg/kg of gentamicin, tobramycin, or netilmicin, with at least a 24 hr dosing interval should be employed and a similar regimen can be applied to amikacin dosing. As yet, there are some patient populations that have not been adequately studied to determine whether or not once-daily aminoglycoside dosing would be a better choice than traditional dosing regimens."
The only thing I'd like to add is to point out that, whereas aminoglycosides exhibit concentration-dependent killing, beta-lactams (usually the other antibiotic in your IV protocol) exhibit time-dependent killing. So it's better to use the beta-lactams more frequently (to give a longer time of exposure of the bugs to the antibiotic over MIC). So you might still need to access that IV site more than once a day. Or so I've read... |
