Once-daily aminoglycoside therapy.

The once-daily administration of aminoglycosides is an attractive concept. In animal experiments and clinical trials, there is either a reduction in or no influence on the risk of toxicity. Less frequent dosing reduces the contact time between host tissue binding sites and drug. Thanks to the PAE and perhaps other as-yet-unrecognized factors, the fall in the level in serum below the MIC does not appear to impair antibacterial efficacy; in fact, the higher peak level in serum may enhance drug efficacy early in a dosage interval. In neutropenic patients, the in vivo PAE may be lost or small-colony variants with a shorter PAE may be selected unless a concomitant beta-lactam is administered. Because it will be some time before data from clinical trials in the United States are available, because the results from the international trials are encouraging, and because there is potential benefit to patients, it seems reasonable for infectious diseases consultants to cautiously initiate the educational process necessary to implement once-daily aminoglycoside therapy in their institutions.