Prins J M, Speelman P
Academic Medical Centre, Department of Internal Medicine, Amsterdam, Netherlands.
Neth J Med. 1998 Jan;52(1):1-9. doi: 10.1016/s0300-2977(97)00071-5.
There is ample evidence that once-daily dosing of aminoglycosides is preferable to the conventional regimens during the treatment of serious infections. Experimental and clinical studies also provide evidence that this regimen can be safely used in children, neutropenic patients and endocarditis. The use of once-daily tobramycin in cystic fibrosis merits further study, as the pharmacokinetics of the aminoglycosides are altered in these patients. The dose-adjustment strategy in patients with renal failure is still controversial, but reducing the daily dose whilst maintaining the q24-h interval has been demonstrated to be safe. Although the value of serum level monitoring in ensuring efficacy and avoiding toxicity has been overestimated in the past, especially in patients with renal failure, an undesirable accumulation of the aminoglycosides can occur. The best way to detect accumulation remains to be defined.
有充分证据表明，在治疗严重感染时，氨基糖苷类药物每日一次给药优于传统给药方案。实验和临床研究也证明，该方案可安全用于儿童、中性粒细胞减少患者和心内膜炎患者。在囊性纤维化患者中使用每日一次的妥布霉素值得进一步研究，因为这些患者体内氨基糖苷类药物的药代动力学发生了改变。肾衰竭患者的剂量调整策略仍存在争议，但已证明在保持每24小时给药间隔的同时减少每日剂量是安全的。尽管过去高估了血清水平监测在确保疗效和避免毒性方面的价值，尤其是在肾衰竭患者中，但氨基糖苷类药物仍可能出现不良蓄积。检测蓄积的最佳方法仍有待确定。
