The traditional approach to parenteral aminoglycoside dosing in adults involves the administration of a weight-based dose divided two to three times daily in patients with normal renal function. The dose is reduced and/or dosing interval extended in patients with decreased renal function. Extended-interval aminoglycoside therapy (also known as once-daily aminoglycosides, single daily aminoglycoside dosing, consolidated or high-dose aminoglycoside therapy) utilizes a higher weight-based dose administered at an extended interval (every 24 hours for those with normal renal function and longer for those with renal dysfunction). Extended-interval aminoglycoside therapy (utilizing higher single doses) should not be confused with traditional, intermittent dosing with lower individual doses administered at 24-hour intervals because of renal impairment.
This topic discusses the efficacy and safety, patient selection, and implementation of these two dosing strategies. Other (general) information about aminoglycosides is found elsewhere. (See "Aminoglycosides".)
This topic refers to dosing of aminoglycosides for the treatment of typical bacterial infections. Dosing of aminoglycosides in the treatment of mycobacterial infections, tularemia, plague, and brucella are discussed in the topics dedicated to those infections.
Of note, for most of these situations, with the exception of urinary tract infections, aminoglycosides are generally used in combination with other agents that have gram-negative activity, regardless of dosing method. (See "Aminoglycosides", section on 'Clinical use'.)
The rapid attainment of therapeutic concentrations of aminoglycosides has been correlated with improved patient outcomes, thus dosing should be optimized to achieve this effect. Additionally, dosing should be tailored to minimize aminoglycoside toxicity. The following general principles apply to all patients, regardless of whether traditional intermittent versus extended-interval daily dosing strategies are used: