 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 April 1996 | Volume 124 Issue 8 | Pages 717-725
Objective: To compare the efficacy, nephrotoxicity, and ototoxicity of once-daily aminoglycoside dosing with those of standard aminoglycoside regimens in immunocompetent adults.
Data Sources: A structured MEDLINE search from 1966 to April 1995 using the keywords aminoglycosides, drug administration schedule, and adult; bibliographic searching of review articles, position papers, and references of the selected articles; contact with primary authors of selected articles to obtain information not in the published reports and lists of potentially relevant articles.
Study Selection: Randomized, controlled trials that 1) compared an intravenous once-daily aminoglycoside regimen with a standard aminoglycoside regimen in infected immunocompetent adults and 2) examined efficacy, mortality, or toxicity.
Data Extraction: For each selected study, two independent reviewers assessed methodologic quality and abstracted data. The heterogeneity of individual study risk ratios was assessed and data were pooled using a random-effects model.
Results: Forty-two studies were reviewed for possible inclusion. Thirteen independent studies met the selection criteria, and their results were pooled. The trials had a mean methodologic quality score of 0.69 (range, 0.50 to 0.91). Heterogeneity exists among the individual risk ratios for clinical cure (P = 0.07); significant heterogeneity does not exist for the other outcomes. For the pooled efficacy outcomes, the risk ratio for bacteriologic cure is 1.02 (95% CI, 0.99 to 1.05), and the risk ratio for mortality is 0.91 (CI, 0.63 to 1.31). For the pooled toxicity outcomes, the risk ratio for nephrotoxicity is 0.87 (CI, 0.60 to 1.26), and the risk ratio for ototoxicity is 0.67 (CI, 0.35 to 1.28).
Conclusions: Standard and once-daily aminoglycoside dosing regimens are equivalent with regard to bacteriologic cure, and once-daily dosing shows a trend toward reduced mortality and toxicity. However, additional studies are needed for more precise estimates of mortality and toxicity risk ratios. The equivalency of the dosing regimens, the ease of administration, reduced nursing time, and reduced variability in the timing of drug administration that are associated with once-daily dosing may mean that the once-daily regimen is clinically advantageous.
Author and Article Information
From McMaster University, Hamilton, Ontario, Canada.
ARTICLE
Once-Daily Aminoglycoside Dosing in Immunocompetent Adults
A Meta-Analysis
Acknowledgments: The authors thank L. Griffith for statistical analysis and J.M. Aguado, D. Gilbert, P. Gonzalez, A. Herchuelz, E. Hippe, W. Kern, R. Maller, J. Prins, E. ter Braak, R.W. Vreede, and P.J. de Vries for their generous responses to our inquiries.
Requests for Reprints: Rosemarie Hatala, MD, Department of Medicine, Henderson General Hospital, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada.
Current Author Addresses: Dr. Hatala: Department of Medicine, Henderson General Hospital, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada.
This article has been cited by other articles:
|
|
 |
|
  Q. Tian, C. D. Gomersall, M. Ip, P. E. Tan, G. M. Joynt, and G. Y. S. Choi Adsorption of Amikacin, a Significant Mechanism of Elimination by Hemofiltration Antimicrob. Agents Chemother., March 1, 2008; 52(3): 1009 - 1013. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Venkataraman and J. A. Kellum Prevention of Acute Renal Failure Chest, January 1, 2007; 131(1): 300 - 308. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Gill, J. V. Nally Jr, and R. A. Fatica Renal Failure Secondary to Acute Tubular Necrosis: Epidemiology, Diagnosis, and Management Chest, October 1, 2005; 128(4): 2847 - 2863. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E Nestaas, H-J Bangstad, L Sandvik, and K-O Wathne Aminoglycoside extended interval dosing in neonates is safe and effective: a meta-analysis Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2005; 90(4): F294 - f300. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia Am. J. Respir. Crit. Care Med., February 15, 2005; 171(4): 388 - 416. [Full Text] [PDF]
|
|
|
|
 |
|
 M.-J. Kim, J. S. Bertino Jr., T. A. Erb, P. L. Jenkins, and A. N. Nafziger Application of Bayes Theorem to Aminoglycoside-Associated Nephrotoxicity: Comparison of Extended-Interval Dosing, Individualized Pharmacokinetic Monitoring, and Multiple-Daily Dosing J. Clin. Pharmacol., July 1, 2004; 44(7): 696 - 707. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. G. Contopoulos-Ioannidis, N. D. Giotis, D. V. Baliatsa, and J. P. A. Ioannidis Extended-Interval Aminoglycoside Administration for Children: A Meta-analysis Pediatrics, July 1, 2004; 114(1): e111 - e118. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C Craig and E. M Hodson Treatment of acute pyelonephritis in children BMJ, January 24, 2004; 328(7433): 179 - 180. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Sung, L. L. Dupuis, B. Bliss, A. Taddio, M. Abdolell, U. Allen, M. Rolland, A. Tong, T. Taylor, and J. Doyle Randomized Controlled Trial of Once- Versus Thrice-Daily Tobramycin in Febrile Neutropenic Children Undergoing Stem Cell Transplantation J Natl Cancer Inst, December 17, 2003; 95(24): 1869 - 1877. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M Baciewicz, D. R Sokos, and R. I Cowan Aminoglycoside-Associated Nephrotoxicity in the Elderly Ann. Pharmacother., February 1, 2003; 37(2): 182 - 186. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Aminimanizani, P. M. Beringer, J. Kang, L. Tsang, R. W. Jelliffe, and B. J. Shapiro Distribution and elimination of tobramycin administered in single or multiple daily doses in adult patients with cystic fibrosis J. Antimicrob. Chemother., October 1, 2002; 50(4): 553 - 559. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Raveh, M. Kopyt, Y. Hite, B. Rudensky, M. Sonnenblick, and A.M. Yinnon Risk factors for nephrotoxicity in elderly patients receiving once-daily aminoglycosides QJM, May 1, 2002; 95(5): 291 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. BLOCK and H. L. MANNING Prevention of Acute Renal Failure in the Critically Ill Am. J. Respir. Crit. Care Med., February 1, 2002; 165(3): 320 - 324. [Full Text] [PDF]
|
|
|
|
|
|
B. Chattopadhyay Newborns and gentamicin--how much and how often? J. Antimicrob. Chemother., January 1, 2002; 49(1): 13 - 16. [Full Text] [PDF]
|
|
|
|
|
|
E. Cohen, A. Dadashev, M. Drucker, Z. Samra, E. Rubinstein, and M. Garty Once-daily versus twice-daily intravenous administration of vancomycin for infections in hospitalized patients J. Antimicrob. Chemother., January 1, 2002; 49(1): 155 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. H. Houlihan, D. P. Stokes, and M. J. Rybak Pharmacodynamics of vancomycin and ampicillin alone and in combination with gentamicin once daily or thrice daily against Enterococcus faecalis in an in vitro infection model J. Antimicrob. Chemother., July 1, 2000; 46(1): 79 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. L. Greene, J. Concato, and A. R. Feinstein Claims of Equivalence in Medical Research: Are They Supported by the Evidence? Ann Intern Med, May 2, 2000; 132(9): 715 - 722. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. LeBrun, L. Grenier, P. Gourde, M. G. Bergeron, G. Labrecque, and D. Beauchamp Effectiveness and Toxicity of Gentamicin in an Experimental Model of Pyelonephritis: Effect of the Time of Administration Antimicrob. Agents Chemother., May 1, 1999; 43(5): 1020 - 1026. [Abstract] [Full Text]
|
|
|
|
|
|
M. Gottfredsson, H. Erlendsdóttir, A. Sigfússon, and S. Gudmundsson Characteristics and Dynamics of Bacterial Populations during Postantibiotic Effect Determined by Flow Cytometry Antimicrob. Agents Chemother., May 1, 1998; 42(5): 1005 - 1011. [Abstract] [Full Text]
|
|
|
|
 |
|
 Aminoglycosides once daily? DTB, May 1, 1997; 35(5): 36 - 37. [Abstract] [Full Text] [PDF]
|
|
Article
