Aminoglycoside monitoring in the once- or twice-daily era. The Dutch situation considered.

The results of an inquiry among Dutch hospital pharmacists on the monitoring of aminoglycosides are presented and the relevance of monitoring is discussed. The vast majority of Dutch hospitals (47 out of 65) use aminoglycosides in a twice-daily dosage regimen, whereas 12 hospitals use a once-daily dose. The timing of peak level sampling is usually 30 min after the end of an intravenous infusion of 20-30 min. Mean 'therapeutic' peak levels of gentamicin were 7-13 mg/l in the once-daily group, 6.4-9.6 mg/l in the twice-daily group and 5-9 mg/l in the small thrice-daily group. Little or no evidence has been published to substantiate a real therapeutic range for aminoglycosides, concerning a relationship between peak or trough levels of aminoglycosides and clinical efficacy, ototoxicity and nephrotoxicity. All studies have been performed with the conventional thrice-daily regimen. No therapeutic range can be defined yet for once-daily or twice-daily aminoglycosides. The monitoring of aminoglycosides may be helpful to reduce the variability in serum levels after a standard dose.