Speelman P. Once versus thrice daily gentamicin in patients with serious infections. There was much trepidation with the first orders written for 500 mg of gentamicin. This article by Nicolau and colleagues 1 describes the experience with a daily dose of 7 mg per kg in over 2,000 patients enrolled in a once-daily aminoglycoside program. With efficacy demonstrated to be equal to that observed in historical controls, the investigators also found a reduction in the rate of observed nephrotoxicity, from 5 percent to 1.2 percent. This rate does not vary significantly in subpopulations of patients such as the elderly, who represented more than a quarter of the Hartford study population.
Prudence dictates that one carefully evaluate one's own experience with a new protocol.
A preliminary study of 98 patients revealed one case of aminoglycoside-induced nephrotoxicity, an incidence remarkably similar to the Hartford data. The monitoring at our institutions will continue. With this protocol, the number of aminoglycoside levels that must be determined has been reduced by half, compared with the number of measurements required with traditional monitoring of the serum aminoglycoside level. Quintiliani R. Experience with a once-daily aminoglycoside program administered to 2,184 adult patients. The article by Trantham 1 on infertile couples was excellent.