Varying dose and interval - Once daily Aminoglycosides (IIb)
R.D. Moore et al: Clinical response to aminoglycoside therapy: Importance of the ratio of peak concentration to minimal inhibitory concentration. J. Infectious Diseases 155(1), 93-99, 1987. J.D. Baggott et al: Clinical pharmacokinetics of amikacin in dogs. American J of Veterinary Research 46(8), 1793 - 1796, 1985.
A new approach to aminoglycoside therapy is being advocated by some infectious disease specialists. Rather than giving amikacin at a dose rate of 10 mg/kg every 8 hours, they advocate single daily doses of 24 mg/kg. The practice in general is referred to as pulse dosing. It relies on an improved kill rate of the bacteria by high concentrations of the antimicrobial, to offset long periods when drug concentrations fall below minimum inhibitory concentrations (MIC). The approach is thought to be as efficacious and less toxic (nephrotoxicity is associated with high trough concentrations rather than high peak concentrations). MIC values for susceptible organisms range from 2 to 8 μg/ml. It requires 2 - 3 x MIC to reach minimum bactericidal concentrations (MBC).