Serial pharmacokinetic dosing of aminoglycosides: a community hospital experience.

The aminoglycoside antibiotics are useful in the treatment of gram-negative bacillary infections but are potentially toxic. A method to maximize their therapeutic benefit while minimizing their risk of toxicity is desirable. Serial pharmacokinetic dosing has been proposed as a method to achieve these goals. An audit was conducted comparing optimal dosing of aminoglycosides by physicians of a community hospital using a serial pharmacokinetic dosing service versus its nonuse. Optimal dosing was 81% (81/101) of trough-peak pairs using the service versus 17% (28/161) not using the service (p less than 0.001). This difference was due to greater achievement of therapeutic peak levels with the service (96%, 97/101) than without (32%, 52/161). There was no difference in toxic trough level occurrence, with 15% (15/101) occurrence with the service and 17% (27/161) occurrence without its use (p greater than 0.05). Clinical nephrotoxicity occurred 0% (0/49) of the time with the use of the service versus 7% (6/88) of the time without its use (p greater than 0.05). The data presented here demonstrate that serial pharmacokinetic dosing of aminoglycosides results in the achievement of therapeutic peak levels in most patients. An understanding of aminoglycoside nephrotoxicity and pharmacokinetics allows the subsequent adjustment of dosing, if necessary, to avoid nephrotoxicity in most patients.