McLean A J, Ioannides-Demos L L, Spicer W J, Christophidis N
Alfred Group of Hospitals, Melbourne, VIC.
Med J Aust. 1996 Jan 1;164(1):39-42. doi: 10.5694/j.1326-5377.1996.tb94111.x.
The safety and efficacy of conventional aminoglycoside dosing regimens have been proven in clinical trials. Higher doses at longer intervals may be more effective if they result in higher peak serum levels of the drug, but few trials of "once-a-day" dosing have shown improved clinical outcome. The clinical safety of allowing trough serum levels to fall below the minimum inhibitory concentration is not established. Literal "once-a-day" dosing will result in drug accumulation and toxicity in patients with reduced renal clearance, and in potential lack of efficacy and the emergence of antibiotic-resistant organisms in those with increased renal clearance. However, modified "once-a-day" dosing, with the interval determined by the individual's renal clearance rate (hence avoiding subtherapeutic trough levels), will avoid these problems.
传统氨基糖苷类给药方案的安全性和有效性已在临床试验中得到证实。如果能使药物血清峰值水平更高，那么延长给药间隔并提高剂量可能更有效，但很少有“一日一次”给药试验显示临床结果得到改善。目前尚未确定允许谷浓度低于最低抑菌浓度的临床安全性。对于肾清除率降低的患者，严格的“一日一次”给药会导致药物蓄积和毒性，而对于肾清除率增加的患者，则可能缺乏疗效并出现抗生素耐药菌。然而，根据个体肾清除率来确定给药间隔的改良“一日一次”给药（从而避免治疗不足的谷浓度）可避免这些问题。
