Rapid HIV-RNA decline following addition of raltegravir and tenofovir to ongoing highly active antiretroviral therapy in a woman presenting with high-level HIV viraemia at week 38 of pregnancy

patients are seen by a doctor at least once every week. All doses ,800 mg are diluted to 20 mL with normal saline. Larger doses are given as the neat 40 mg/mL solution supplied in the manufacturers’ vials. In the period between November 1995 and October 2009, we documented the administration of 5593 doses (3652 of tobramycin and 1941 of gentamicin). The drugs were administered in 361 courses (244 of tobramycin and 117 of gentamicin) to 132 patients. Sixty-seven of these patients had cystic fibrosis and received multiple courses. Twelve of the remaining 65 had bronchiectasis and also received more than one course. The other remaining patients were treated for a variety of diagnoses, typically requiring only one course. One hundred and forty-five courses were administered to children and 216 to adults. The ages of the patients ranged from 3 to 84 years. The median dose was 360 mg of tobramycin and 320 mg of gentamicin in cystic fibrosis, and 240 mg of tobramycin and 170 mg of gentamicin in those without cystic fibrosis. The median course duration was between 15 and 18 days across the same groups. One patient, a middle-aged female with complex medical problems, developed vestibular toxicity and some hearing loss 16 h after her last dose of 320 mg of tobramycin. There has never been the suggestion of neuromuscular toxicity or hearing loss at the time of injection. Current recommendations are that tobramycin and gentamicin be given by infusion over ≥30 min. We have shown that tobramycin and gentamicin can be safely administered by slow push over 3–5 min. We recommend that consideration be given to the use of this simple method as the standard of care.