Aminoglycoside Dosing Considerations in Intensive Care Unit Patients

OBJECTIVE: Factors affecting aminoglycoside dosing requirements in critically ill adult patients were reviewed. DATA SOURCES: A literature search was performed from 1979 to 1992 and articles pertaining to aminoglycoside dosing were obtained. STUDY SELECTION: Only studies appearing in peer-reviewed journals were selected. Topics selected included: Bactericidal kill kinetics, once-daily dosing regimens, critical illness, toxicity, aminoglycosides, intensive care unit, and lung penetration. CONCLUSIONS: Studies suggest that larger initial aminoglycoside doses are necessary in critically ill patients (tobramycin/gentamicin 3 mg/kg or amikacin 9 mg/kg) to achieve adequate peak serum concentrations. Current studies have not shown an increase in the incidence of aminoglycoside toxicity when using these larger initial doses. Follow-up monitoring is dependent upon the patient's physiology and risk factors for aminoglycoside-induced toxicity.