title: Once versus individualized multiple daily dosing of aminoglycosides in critically ill patients.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the once daily dosing (ODD) program in critically ill Egyptian patients compared to individualized multiple daily dosing (MDD) in terms of clinical and bacteriological efficacy. In addition, the incidence of nephrotoxicity associated with both regimens in this specific group of patients was assessed.
  
  
  METHODS
  Fifty-two patients with suspected or confirmed bacterial infections admitted to the Critical Care Medicine Department, Kasr El-Aini-Cairo University Hospitals comprised the study population. The amikacin group (30 patients) was sub-divided into 14 patients receiving amikacin ODD (1 g i.v.) and 16 patients receiving amikacin in MDD (500 mg i.v./dose). The gentamicin group (22 patients) was sub-divided into 10 patients receiving the drug ODD (240 mg i.v.) and 12 patients receiving gentamicin MDD (80 mg i.v./dose). Amikacin or gentamicin serum levels were determined by the enzyme multiplied immunoassay technique using Emit 2000. MDD regimen was adjusted based on the individual pharmacokinetic parameters using the Sawchuk-Zaske method.
  
  
  RESULTS
  There was no significant difference between the two dosing regimens with regard to clinical and antibacterial efficacy or incidence of nephrotoxicity of both gentamicin and amikacin groups. In the ODD regimen, duration of treatment had no effect on increasing incidence of nephrotoxicity unlike the individualized MDD regimen. No dose adjustments were needed in the once daily dosing regimen since trough concentrations have never been above toxic level.
  
  
  CONCLUSIONS
  The study showed that the ODD regimen is preferred in critically ill patients to individualized MDD as shown by comparable efficacy, nephrotoxicity and lesser need for therapeutic drug monitoring and frequent dose adjustments required in the individualized MDD regimen.
authors: Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
authors: A
authors: A
authors: Abdel-Bari
authors: M Sherif
authors: MS
authors: Mokhtar
authors: Nagwa Ali
authors: NA
authors: Sabry
authors: Sanaa Abd
authors: SA
authors: El-Shafi
authors: Naglaa Samir
authors: NS
authors: Bazan
keywords: Aminoglycosides; Critically ill; Once daily; Pharmacokinetics
references: Orthopedics. 2005 Feb;28(2):125-7
references: 15751365
references: Eur J Clin Microbiol Infect Dis. 1995 Feb;14(2):88-91
references: 7758492
references: J Infect Dis. 1974 Feb;129(2):187-93
references: 4810941
references: Chronobiol Int. 1993 Aug;10(4):259-70
references: 8403069
references: Lancet. 1993 Feb 6;341(8841):335-9
references: 8094114
references: Am J Med. 1996 Aug;101(2):177-83
references: 8757358
references: Clin Pharmacol Ther. 1997 Jul;62(1):106-11
references: 9246024
references: J Antimicrob Chemother. 1997 Jun;39(6):677-86
references: 9222035
references: Antimicrob Agents Chemother. 1975 Jul;8(1):58-62
references: 1164007
references: J Antimicrob Chemother. 1991 May;27 Suppl C:91-103
references: 1856149
references: J Antimicrob Chemother. 1988 Jul;22(1):75-9
references: 3170393
references: J Infect Dis. 1975 Aug;132(2):165-74
references: 808583
references: J Infect Dis. 1971 Dec;124 Suppl:S130-7
references: 5126239
references: Nihon Rinsho. 1995 Sep;53(9):2301-9
references: 7474397
references: Antimicrob Agents Chemother. 1995 Mar;39(3):650-5
references: 7793867
references: Kidney Int. 1988 Apr;33(4):900-11
references: 3290565
references: Int J Antimicrob Agents. 2002 Apr;19(4):341-8
references: 11978505
references: J Antimicrob Chemother. 1990 Jan;25(1):159-73
references: 2108113
references: Am J Med. 2003 Feb 15;114(3):194-8
references: 12637133
references: J Chemother. 1996 Aug;8(4):278-83
references: 8873833
references: Int J Antimicrob Agents. 2009 Mar;33(3):201-5
references: 18976888
references: Surgery. 1998 Jul;124(1):73-8
references: 9663254
references: Ann Pharmacother. 1993 Nov;27(11):1333-9
references: 8286803
references: Br J Clin Pharmacol. 1995 Jun;39(6):605-9
references: 7654477
references: Ann Intern Med. 1993 Oct 1;119(7 Pt 1):584-93
references: 8363169
references: Clin Pharmacokinet. 1991 May;20(5):374-88
references: 1908755
references: Antimicrob Agents Chemother. 1999 Jul;43(7):1549-55
references: 10390201
references: Pharmacotherapy. 1999 Nov;19(11):1252-60
references: 10555931
references: Ther Drug Monit. 2007 Oct;29(5):632-7
references: 17898655
references: J Pharmacokinet Biopharm. 1976 Apr;4(2):183-95
references: 950590
references: Ann Pharmacother. 1993 Mar;27(3):351-7
references: 8267695
references: J Antimicrob Chemother. 1991 May;27 Suppl C:73-9
references: 1906864
references: Toxicol Lett. 1988 Feb;40(2):175-82
references: 2893472
references: Clin Obstet Gynecol. 2008 Sep;51(3):498-506
references: 18677142
references: Antimicrob Agents Chemother. 1991 Mar;35(3):399-405
references: 2039189
references: Antimicrob Agents Chemother. 1982 Mar;21(3):407-11
references: 7103444