Dosing aminoglycosides once a day

: In the past few decades aminoglycosides have usually been administered as multiple daily dosing regimens. However, animal experiments have shown that nephrotoxicity can be reduced if, with the same total daily dose, the dosing interval is spread out. Further, several in-vitro and in-vivo studies suggest that once-daily dosing may be more effective. In 24 randomized, clinical trials, once- vs. multiple daily dosing regimens of amikacin, netilmicin and gentamicin have been compared in a total of 3181 patients. An analysis of these studies revealed significant advantages in favour of once-daily dosing for both clinical efficacy (89.5% vs. 84.7%, p < 0.001) and bacteriological efficacy (88.6% vs. 83.4%, p < 0.01). In addition, improved but not statistically significant results were obtained with once-daily dosing with regard to nephrotoxicity (4.5% for once-daily vs. 5.5% for multiple daily dosing) and ototoxicity (4.2% vs. 5.8%). Furthermore, once-daily dosing is cheaper, as less infusions are required and the expense of monitoring serum levels can be reduced. In conclusion, amikacin, netilmicin and gentamicin can be administered once a day.