title: Once versus twice daily gentamicin dosing for infective endocarditis: a randomized clinical trial.
abstract: OBJECTIVE
  The aim of this randomized study was to investigate the effects of once versus twice daily gentamicin dosing on renal function and measures of infectious disease in a population with infective endocarditis (IE).
  
  
  METHODS
  Seventy-one IE patients needing gentamicin treatment according to guidelines were randomized to either once (n = 37) or twice daily (n = 34) doses of gentamicin. Kidney function (glomerular filtration rate, GFR) was measured with an isotope method ((51)Cr-EDTA) at the beginning of treatment and at discharge. Treatment efficacy was assessed by C-reactive protein (CRP) time to half-life, mean CRP and leukocytes.
  
  
  RESULTS
  Baseline GFR was similar in the two groups. Both groups displayed a significant fall in GFR from admission to discharge. The mean decrease in GFR was as follows: with once daily gentamicin, 17.0% (95% confidence interval 7.5-26.5), and with twice daily gentamicin, 20.4% (95% confidence interval 12.0-28.8). However, there was no significant difference in the GFR decrease between the once and twice daily regimens (p = 0.573). No difference in infection parameters was demonstrated between the two dosing regimens.
  
  
  CONCLUSIONS
  A twice daily gentamicin dosing regimen is neither less nephrotoxic nor more efficient than a once daily regimen in the treatment of IE patients. When indicated, gentamicin may therefore also be administered as a single-dose regimen in the treatment of IE patients.
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark. krisbuch @ vip.cybercity.dk
authors.forename: Kristine
authors.initials: K
authors.lastname: Buchholtz
authors.forename: Carsten Toftager
authors.initials: CT
authors.lastname: Larsen
authors.forename: Bente
authors.initials: B
authors.lastname: Schaadt
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.forename: Niels Eske
authors.initials: NE
authors.lastname: Bruun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000592:standards; D002097:C-Reactive Protein / Q000032:analysis; D003718:Denmark; D004334:Drug Administration Schedule; D004696:Endocarditis / Q000188:drug therapy*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000009:adverse effects* / Q000592:standards; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006207:Half-Life; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002097:C-Reactive Protein