title: Tobramycin dosing in the puerperal patient.
abstract: Serum levels of tobramycin were determined with an enzyme immunoassay technique in 20 puerperal women with postcesarean endometritis who were being treated with metronidazole-tobramycin. Ideal dosing was then calculated to attempt to provide peak serum levels between 5 and 8 micrograms/mL and trough serum levels less than 2 micrograms/mL. In eight patients, therapeutic serum levels could not be attained even at doses greater than the package-insert recommendation of 3 mg/kg/d. Therapeutic levels were achieved in five patients with doses between 3 and 5 mg/kg/d and in seven patients only at doses above the maximum recommended daily dose of 5 mg/kg. The puerperal patient appears to usually require much higher dosages of tobramycin than usual, and serum levels must be monitored for therapeutic reasons rather than for toxicity.
mesh_terms: D002585:Cesarean Section; D004359:Drug Therapy, Combination; D004716:Endometritis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007700:Kinetics; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy; D011247:Pregnancy; D011644:Puerperal Disorders / Q000188:drug therapy*; D014031:Tobramycin / Q000008:administration & dosage* / Q000378:metabolism / Q000627:therapeutic use
chemical_list: D008795:Metronidazole; D014031:Tobramycin