Use of Large-Dose Gentamicin Regimens in Elderly Men

Abstract

The use of large-dose aminoglycosides (LDAs), also called “once-daily” aminoglycosides, has been increasing. We have used LDA regimens in almost all patients needing aminoglycosides since 1995. However, some concerns exist about the use of these regimens in elderly patients. At our institution, a retrospective, 2-year review was conducted to assess changes in serum creatinine, duration of therapy, and drug concentrations in patients older than 65 years of age. A total of 111 patients (all men) were evaluated. Of these, six had documented increases in serum creatinine of Ž 0.5mg/dL. All patients had risk factors (eg, prolonged duration of therapy) for changes in renal function. Most patients tolerated their LDA regimens; the median duration of therapy was 4.5 days. LDA regimens may be used in elderly men with a low incidence of nephrotoxicity provided that the dosing interval is adjusted empirically based on estimates of renal function and that the duration of therapy is minimized.