CLINICAL APPLICATION OF PHARMACOKINETICS
IN ADJUSTING GENTAMICIN DOSAGE:
CASE REPORTS
by Sylvia M. Wallace, Kathy Gesy, and Dennis K. J. Gorecki
GENTAMICIN is an aminoglycoside antibiotic whose
primary therapeutic role is the treatment of infections
caused by gram-negative Enterobacteriaceae and
Pseudomonas aeruginosa.! To ensure that the anti-
biotic will be effective, particularly in life-threatening
infections, an adequate dose of gentamicin must be
administered. However, because gentamicin has a low
therapeutic index, the drug must be administered with
caution to ensure that patients do not receive a toxic
dose. Toxic effects on the auditory-vestibular appara-
tus and the kidney can result in hearing loss, loss of
equilibrium, and acute renal tubular necrosis. The
incidence of toxic effects can be related to the dosage
of drug, length of treatment, preexisting renal dys-
function, and age of the patient. 1
Gentamicin is eliminated from the body primarily
by renal excretion. Total body clearance of genta-
micin is directly proportional to creatinine clearance."
The elimination half-life ranges from two to three hours
in patients with normal renal function," up to 69 hours
in anuric patients.' For most clinical applications, the
half-life is calculated assuming gentamicin pharma-
cokinetics can be described by a one-compartment
model. If serum samples are obtained for a prolonged
period (e.g., 120 hours"), the decline of serum levels
is biphasic and can be described by a two-compart-
ment pharmacokinetic model. The slower elimination
(13) phase has an average half-life of 53 hours in pa-
tients with normal renal function and 173 hours in
patients with a creatinine clearance of less than 25
ml/rnin."
Gentamicin disposition is also affected by a number
of other physiologic and pathologic conditions." Be-
cause gentamicin is distributed less to adipose tissue
than to other tissues, the relative volume of distribu-
tion is lower in obese subjects than in subjects with
normal weight.6 Prediction of serum levels is more
accurate when based on estimates of lean body weight
(LBW) than on total body weight (TBW).4 Volumes
of distribution in patients with ascites appear to be
larger than in normal patients."
SYLVIA M. WALLACE, B.S.P., Ph.D., is Associate Pro-
fessor, College of Pharmacy; KATHY GESY, B.S.P., is
Lecturer, College of Pharmacy; and DENNIS K. J.
GORECKI, B.S.P., Ph.D., is Director, Pharmaceutical
Research and Analysis Laboratory, College of Phar-
macy, University of Saskatchewan, Saskatoon, Sas-
katchewan, Canada.
Address correspondence and reprint requests to Dr. S. M.
Wallace, College of Pharmacy, University of Saskatchewan,
Saskatoon, Saskatchewan, Canada S7N OWO.
Drug Intelligence and Clinical Pharmacy VOL 15
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Both therapeutic and toxic effects of gentamicin are
related to dose and serum levels of the drug. For
treatment of most infections, peak serum levels of
5-8 I.l.g/ml are effective. Slightly higher concentrations
(8-10 f.l.g/ml) may be required to treat pneumonias."
High peak serum levels occur more frequently in
patients who develop ototoxicity. Jackson and Ar-
cieri report 10 of 19 patients exhibiting ototoxicity as
having gentamicin serum levels greater than 8 f.l.g/ml,
with seven of the ten having levels between 16 and
40 I.l.g/ ml, 9 Patients with trough levels higher than 2
I.l.g/ ml exhibit a higher incidence of nephrotoxicity. 1 0
To minimize toxicity, dosage regimens should be de-
signed to avoid excessive serum levels of gentamicin,
(that is, peak levels greater than 10-12 f.l.g/ml and
trough levels above 2-3 f.l.g/ml). 8
Because of a low therapeutic index and variability
in gentamicin disposition, dosage should be individ-
ually adjusted for each patient. Since elimination of
gentamicin is primarily dependent on renal function,
most methods of adjusting dosages for patients rely
on an estimate of kidney function (e.g., serum crea-
tinine, creatinine clearance). 4,11 If serum levels of
gentamicin are measured, more precise definition of
pharmacokinetic parameters and adjustment of dos-
age are possible.!" Since the dosage required to main-
tain therapeutic but nontoxic drug levels is different
for each patient, the correct balance can best be
achieved by a judicious choice of the initial regimen
(determined with reference to kidney function) ,
measurement of drug levels, and subsequent adjust-
ment of dosage.
In our experience, methods for predicting genta-
micin levels and designing optimal dosage schedules
are most successful in patients with average weight,
good renal function, and relatively stable clinical con-
dition. Despite the accumulation of pharmacokinetic
information relating to the aminoglycoside antibiotics,
pharmacokinetic predictions alone cannot anticipate
the physiologic and pathologic changes that occur in
many hospitalized patients with acute illnesses. The
following case histories were selected to illustrate the
use of pharmacokinetic monitoring of patients, and to
emphasize the necessity of clinical assessment to mod-
ify recommendations based on pharmacokinetic an-
alysis.
All case histories reported are for inpatients at
Saskatoon City Hospital (Saskatoon, Saskatchewan).
All serum samples were analyzed in duplicate by
radioimmunoassay (New England Nuclear commer-
cial kit, Rianenw) at the Pharmaceutical Research and
SEPT 81 651
Analysis Laboratory of the College of Pharmacy,
University of Saskatchewan.
Gentamicin was administered by intravenous in-
fusion for a period of ¥2 to I hour as ordered by the
physician. The exact time of starting and stopping the
infusion was noted by the nursing staff. Blood sam-
ples for measurement of gentamicin levels were usually
drawn when the patient was at steady state, immedi-
ately prior to a dose, and 30 minutes postinfusion.
The exact time of blood collection was noted by the
phlebotomist. Serum was separated from blood and
analyzed for gentamicin by radioimmunoassay. The
serum gentamicin levels were plotted on semi-logarith-
mic graph paper (logarithm of concentration against
time) . The serum level measured before the dose
was assumed to also represent the level which would
be achieved at the end of the following dosing interval
(since the patient was at steady state). The elimina-
tion half-life (t¥2) was estimated from the graph.
The peak concentration (C max) was estimated by ex-
trapolating the graph to the time the infusion had
terminated. The volume of distribution (V d) was
estimated from the measured gentamicin levels using
the following equation: 12
_ k, (1- e-kdt')
V d - kd(Cmax-Cmine-k dt)
' Eq. I
where k, = infusion rate (mg gentamicin/h); k d=
elimination rate constant (0.693/t¥2); t' = length of
the infusion (h); C max = peak gentamicin concentra-
tion, that is, at the end of the infusion (ug/rnl};
and C min = trough gentamicin concentration at the end
of the previous dosing interval (}-lg/ml).
The dosage required to achieve a therapeutic peak
and trough level at steady state was calculated from
Equation 2, where T= dosage interval:
k = CmnxkdVd (I - e-kdT)
o (1- e-kdt') Eq. 2
This dosage was rounded to the nearest easily admin-
istered dose and the peak and trough that would
be achieved at this infusion rate calculated as:
Eq.3
Eq.4
Lean body weight (LBW) was estimated as: 13
LBW (Males) = 50 kg + 2.3 kg/inch of height
over 5 ft.
LBW (Females) =45.5 kg + 2.3 kg/inch of
height over 5 ft.
CASE REPORTS
CASE 1
A 56-year-old female (weight 48 kg, height 5') was
admitted May 30 with a one-month history of chills,
weight loss, and general malaise. On admission, the
patient was febrile (T 38.2°C); laboratory tests were:
652
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white blood count (WBC) 15900 with left shift, hemo-
globin (Hb) 10.6 g/100 ml, hematocrit (Hct) 31.5%,
sodium 137 mEq/L, potassium ·4.6 mEq/L, chloride
102.5 mEq/L, blood urea nitrogen (BUN) 8 mg/lOO
ml, serum creatinine 1.2 mg/lOO ml. Blood and urine
cultures showed no bacterial growth. Vaginal cultures
showed growth of Enterobacter cloacae sensitive to
gentamicin. The preliminary diagnosis was pelvic peri-
tonitis with possible abscess.
Gentamicin therapy (80 mg iv q8h) and ampicillin
1 g iv q6h were initiated at 2200 h May 30. Serum
gentamicin levels were determined June 2 before and
after administration of the ninth dose. A peak level
of 11.4 .ug/ml and a trough level of 2.5 .ug/ml were
achieved. A decrease in dose to 50 mg iv q8h was
recommended. Forty hours after decreasing the dose,
serum gentamicin levels were 7.9 ~(g/ml for the peak
and 2.2 .ug/ml for the trough.
Clindamycin 300 mg q6h was started June 4. On
June 5, examination by ultrasound revealed a pelvic
mass. A laparotomy was performed June 10. A fixed,
poorly differentiated carcinoma of the pelvis was diag-
nosed and removed. Antibiotics were discontinued
June 13. The patient was discharged in good condition
June 20.
This patient had good renal function, average body
weight, and remained relatively stable throughout the
period of hospitalization. Her serum creatinine re-
mained between 1.0 and 1.2 mg/IOO ml. The dosage
initially prescribed was too high and necessitated a
reduction. The schedule recommended (50 mg q8h),
based on estimation of the patient's Ve (7.9 L) and
t¥2 (3.7 h) from the gentamicin levels measured, was
predicted to achieve a peak serum level of 7.4 }-lg/ml
and a trough level of 2.2 }-lg/ml. The peak level
achieved was 7.9 }-lg/ml and the trough, 2.2 }-lg/ml.
CASE 2
A 74-year-old male (weight 90 kg, height 5'6") was ad-
mitted to the Intensive Care Unit (lCU) June 3 with
signs of intestinal obstruction. On examination, the
patient exhibited cyanosis and a distended abdomen.
He was vomiting, sweating, and had clammy skin. His
pulse was weak and blood pressure was not recordable.
The preliminary diagnosis was peritonitis secondary
to obstruction and perforation of the small bowel.
Ampicillin 1 g iv q6h was ordered on admission.
Laboratory data on admission were: WBC 11 100,
Hb 19.1 g/100 ml, Hct 54%, sodium 142 mEq/L, po-
tassium 4 mEq/L, chloride 92.5 mEq/L, BUN 64
mg/100 ml, serum creatinine 3.4 mg/l00 ml. The pa-
tient had no history of renal disease.
Surgery was performed June 3, and a small segment
of his small bowel was resected. The patient was
digitalized (lanatoside C 0.4 mg iv) and curarized (pan-
curonium bromide) during surgery and was main-
tained on a respirator after surgery. Dopamine was
administered by an intravenous infusion with the rate
of administration adjusted to maintain a systolic blood
pressure of 90 mm Hg. Intravenous fluids and albu-
min were administered to maintain central venous pres-
sure.
Gentamicin 80 mg iv was administered (l h dura-
tion) before surgery at 2030 h June 3. Because of his
high serum creatinine and poor renal function, serum
samples were analyzed before administering the next
dose of gentamicin. Gentamicin levels were 1.85
I.(g/ml at 0800 hand 1.15 .ug/ml at 1400 h on June 4.
Elimination t\.02 and Vd estimated from these measure-
ments were 9 hand 18 L (28 percent LBW), respec-

tively. Based on these pharmacokinetic parameters, a
dose of 100 mg q24h was recommended. Gentamicin
100 mg was administered at 1800 h June 4 and 5.
The patient developed an erythematous rash June 4.
Ampicillin was discontinued June 5, and two doses of
chlorpheniramine 10 mg iv q 12h were administered.
Serum gentamicin levels were repeated June 6 at
0800 h (3.6 .ug/ml) and 1330 h (2.6 .ug/ml). The t l/ 2
had increased to 12 hand V<\ decreased slightly to
16 L. Serum creatinine during this period rose from
3.4 to 3.5 mg/lOO mI. The schedule of 100 mg q24h
was maintained June 6 through 8. By June 8, the
patient's condition was stable and gradually improving.
His abdomen was moderately distended with indica-
tions of some fluid accumulation. In fact, he had
accumulated a positive fluid balance of approximately
4 L. Serum creatinine decreased to 2.4 mg/lOO ml
June 7, and then to 1.4 mg/100 ml June 8. Serum gen-
tamicin levels measured June 9 were 1.5 .ug/ml at 0810
hand 1.05 .ug/ml at 1315 h. Based on these measure-
ments, the t'l2 had decreased slightly to 10 h and the
V<\ increased significantly to 32 L (50 percent LBW).
The extrapolated value for the peak serum level was
5 .ug/mI. The gentamicin dosage was then increased to
120 mg q24h. The patient continued to improve, and
the dopamine was discontinued June 10. His daily
fluid balance became negative. On June 11, serum
levels of gentamicin measured at 0830 hand 1300 h
were 1.4 .ug/ml and 0.6 .ug/ml, respectively. Reflect-
ing the improvement in renal function, the tlh for
gentamicin had decreased significantly to 3.7 h (serum
creatinine on June 10 was 1.2 mg/lOO ml), With the
disappearance of peritoneal fluid accumulation, the V <1
had returned to normal (16 L, 25 percent LBW). With
the decrease in t'l2, a change in the dosage schedule to
90 rng q12h was recommended. By June 16, his wound
was healing, and he had been extubated, no longer re-
quiring the respirator. The gentamicin was discon-
tinued. The patient returned to the ward June 17 and
was discharged June 24.
With rapidly changing renal function, significant
changes in gentamicin disposition were anticipated.
Changes in gentamicin half-life did not coincide with
the changes in serum creatinine. The half-life re-
mained prolonged for several days after the serum
creatinine began to decrease. Coupled with the
changes in renal function, the V<\ changed dramatically
during the course of the patient's hospital stay. Peri-
toneal fluid accumulation produced marked distension
of his abdomen. The V<\ increased to 50 percent LBW
and then returned to normal (25 percent LBW) when
the fluid had dissipated. Although the V d in most
patients is estimated as 20-25 percent LBW, V<\ values
of 31-84 percent LBW have been reported for pa-
tients with ascites.' In a patient with an abnormally
large V,), pharmacokinetic predictions must be tem-
pered by clinical judgment. Anticipating that the
fluid accumulation and V d increase (from 16 to 32 L)
were transient, the gentamicin dosage was not doubled
but was only increased from 100 to 120 mg q24h. As
the patient's condition stabilized with a normal VII,
decreased serum creatinine, and decreased gentamicin
half-life, the dosing interval was decreased from 24 to
12 hours to maintain therapeutic levels for longer
periods.
The dosage schedule required to maintain therapeu-
tic levels of gentamicin in this patient was variable.
Drug Intelligence and Clinical Pharmacy VOL 15
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GENTAMICIN DOSAGE
Both half-life and V<\ changed significantly. For such
patients, serum gentamicin levels should be measured
frequently and gentamicin dosage adjusted accord-
ingly. Laboratory tests as well as the clinical status
of the patient should alert the pharmacist or physician
and help to identify patients requiring frequent serum
level monitoring. In this case, decreasing serum cre-
atinine indicated a gradual improvement in renal func-
tion while marked abdominal distension indicated a
significant accumulation of peritoneal fluid.
CASE 3
A 56-year-old male (weight 90 kg, height 5'10") was
admitted May 17 with fever, chills, sweating, and left
subcostal pleuritic pain. During the previous two
weeks, the patient had complained of increased short-
ness of breath, decreased energy, and frontal head-
aches. He had experienced recurrent respiratory in-
fections for the past six months. The patient was re-
ferred with a preliminary diagnosis of acute leukemia.
On admission his vital signs were: P 88 and regular,
BP 120/80 mm Hg, and T sti-c. A chest X-ray
showed signs of left lower lobe consolidation. Labora-
tory tests on admission were: WBC 33 100 (with 1%
neutrophils, 18% lymphocytes, 27% monocytes, and
35% blast cells), Hb 10.3 g/lOO ml, Hct 31.2%, plate-
lets 152000, sodium 142 mEq/L, potassium 4.2
mEq/L, chloride 105 mEq/L, BUN 18 mg/IOO ml,
and serum creatinine 1.1 mg/l00 ml,
Cephalothin 1 g iv q6h and gentamicin 100 mg iv
were administered at 1230 h May 18 followed by
gentamicin 80 mg q8h beginning at 2200 h. Serum
gentamicin levels were analyzed May 20 before and
after administration of the eighth dose. The peak
level was 3.75 .ug/ml and the trough, 0.9 .ug/mI. On
May 22, the dose was increased to 120 mg q8h at
1400 h.
Laboratory reports confirmed a diagnosis of acute
myelomonocytic leukemia with possible left lower lobe
infiltration. Chemotherapy (adriamycin 30 mg iv for
3 d and cytosine arabinoside 150 mg for 5 d) was
scheduled for May 21. Metoclopramide (10 mg iv
before adriamycin and cytosine arabinoside) and chlor-
promazine (25 rng im prn) were ordered to control
nausea.
Gentamicin levels were measured May 27. With a
dose of 120 mg q8h, a peak of 10.3 .ug/ml and a
trough of 2 .ug/ml were achieved. A chest X-ray
showed clearing of left lung consolidation; the anti-
biotics were discontinued May 29.
Two days after discontinuing the gentamicin therapy,
the patient developed a dental abscess and gentamicin
therapy was reinstituted at a loading dose of 120 mg
followed by 100 mg iv q8h. The peak level on this
regimen was 6.8 .ug/ml and the trough, 1.8 .ug/mI.
Initial estimates of pharmacokinetic parameters
based on a peak level of 3.75 f.lg/ml and a trough
level of 0.9 f.lg/ml for a dosing schedule of 80 mg q8h
were 3.6 h for the half-life and 26 L (37 percent
LBW) for V<\. The V<\ is large and perhaps due, in
part, to accumulation of fluid. The daily fluid balance
remained positive until May 23. Pharmacokinetic
parameters determined May 27, nine days after start-
ing the gentamicin and five days after increasing the
dosage, reflected a change in the patient's clinical con-
dition. Although the half-life remained essentially
unchanged (3.4 h), the v, decreased to 12.5 L (17
percent LBW). From May 21-25 the patient received
SEPT 81 653
chemotherapy during which time he experienced
nausea and vomiting and did not eat regularly. Be-
tween admission (May 17) and May 24, the patient
lost 3 kg of body weight. His renal function, as mon-
itored by serum creatinine, remained unchanged (1.1
mg/ 100 ml). The decreasing V d could be attributed
to clearing of the pleural exudate as well as to fluid
and weight loss during chemotherapy.
When gentamicin was reinstituted June 2, the half-
life remained approximately the same (3.7 h). The
Ve increased to 17.7 L (24 percent LBW), a value
within the normal range. The patient was once again
eating well; nausea and vomiting due to the chemo-
therapy had ceased.
Although the patient's half-life remained relatively
constant throughout the course of gentamicin therapy,
the Ve changed significantly. The changes in Ve re-
flected changes in the patient's clinical condition, that
is, from abnormal fluid accumulation to dehydration
secondary to prolonged nausea and vomiting. Any
dosing recommendations based on pharmacokinetic
predictions must be influenced by the clinical changes
noted. With prior knowledge that the patient is to
receive a chemotherapy regimen, which often produces
nausea and vomiting, contraction of the V<\ for genta-
micin should be anticipated. Any adjustments in dos-
age should be conservative. Thus, although initial
estimates of pharmacokinetic parameters in this case
suggest a doubling of the dose (from 80 to 160 q8h),
the dosage increase recommended should be con-
servative (from 80 to 120 mg q8h). In addition,
serum levels should be monitored more frequently
during chemotherapy since the exact change in V d
cannot be predicted.
CASE 4
A 3 I-year-old male (weight 43.2 kg, height 5'4") with
advanced muscular dystrophy was admitted to the ICU
April 30 with respiratory failure, acute bronchitis, in-
creasing dyspnea, and retention of bronchial secretions.
The patient had severe pulmonary restriction because
of skeletal deformity and musculoskeletal weakness.
Ampicillin 500 rng iv q6h was administered April 30.
A tracheostomy was performed May 3. By May 7, the
patient had developed bilateral pleural effusions in both
lung bases and had accumulated a fluid balance of 7 L.
Furosemide (up to 40 mg q6h) was administered.
Sputum cultures of May 7 reported growth of Klebsiella
pneumoniae and Pseudomonas maltophilia resistant to
the aminoglycosides and ampicillin; sensitive to carbeni-
cillin, sulfonamides, and co-trimoxazole. Sulfisoxazole
0.5 g qid was administered. On May 21, the patient
was still febrile (39°C) and had developed an erythe-
matous rash. Ampicillin was discontinued, and ceph-
alexin 500 mg qid was started. On May 30, sputum
cultures showed light growth of Pseudomonas aeru-
ginosa (sensitive to cephalosporins and gentamicin). A
chest X-ray showed evidence of right lower lobe pneu-
monia. Cephalexin and sulfisoxazole were discontinued.
Cephalothin 500 mg iv q6h and gentamicin 80 mg iv
q8h were initiated at 1700 h on May 30. Laboratory
tests of May 23 were: WBC 10 300, Hb 14.9 g/IOO ml,
Hct 47.4%, sodium 137 mEq/L, potassium 3.4 mEq/L,
chloride 82 mEq/L, BUN II mg/100 ml, and serum
creatinine 0.3 mg/100mI.
Serum levels of gentamicin on June 2 were a trough
of 3.4 J.tg/ml and a peak of II J.tg/mI. Based on phar-
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macokinetic parameters, a decrease in dose to 70 mg
q12h was recommended. Levels measured after dose
reduction were 8 J.tg/ml for the peak and 1.2 J.tg/ml
for the trough.
In patients with muscular dystrophy, serum cre-
atinine cannot be used as a measure of renal function
to aid in the adjustment of dosage of the aminoglyco-
side antibiotics. As in this patient, serum creatinine
is low because of a decreased rate of creatinine pro-
duction. Serum concentrations of creatine and cre-
atine phosphokinase are elevated.l! Other tests of
renal function such as inulin and p-arninohippurate
clearance give normal values.
The half-life, as estimated from measured genta-
micin levels, was 4 h and the V d, 9 L (21 percent
LBW) . As a result, a dosing interval longer than
eight hours was required to maintain a trough level
below that associated with toxicity (2 flg/ml), but a
peak level high enough for treatment of pneumonia
(8 flg/ml). The primary aim in altering the dosage
schedule from 80 mg q8h to 70 mg q12h was to de-
crease the trough level of 3.4 flg/ml. The peak and
trough values predicted using Equations 3 and 4, a
t~ of 4 h, V<\ of 9 L, and a dosage schedule of 70
mg q 12h were 8.2 ltg/ ml and 1. 3 flg/ ml,
Pharmacokinetic models of gentamicin dosing can-
not be applied in isolation. Clinical assessment of the
individual patient is of major importance and will, in
many cases, determine the outcome of dosage recom-
mendations. The preceding cases, encountered in our
pharmacokinetic practice, are meant to serve as ex-
amples of how practical application of pharmaco-
kinetics must be tempered with clinical judgment.e-
We wish to thank the pharmacists, physicians, laboratory
technologists, and nurses of Saskatoon City Hospital for
their cooperation and assistance in conducting the pharma-
cokinetic service.
KEY WORDS: pharmacokinetics, gentamicin, serum concen-
trations, aminoglycoside antibiotics.
EXTRACTO
Los model os farmacocineticos para dosificar gentamicina no
pueden aplicarse aisladamente. Los cambios fisiologicos y
patologicos que ocurren en muchos pacientes hospitalizados
cuyo estado clinico es inestable no pueden ser anticipados
por predicciones farrnacocineticas unicarnente. Se presentan
cuatro casos para ilustrar el uso de vigilancia farmacocinetica
en pacientes y para enfatizar la necesidad de utilizar la
evaluacion clinica del paciente para modificar aquellas re-
comendaciones basadas en analisis farmacocinetico,
Luz M. GUTIERREZ
RESUME
Le faible index therapeutlque de la gentamicine, antibiotique
de la c1asse des aminoglycosides, est bien documente, Des
pies seriques superieurs a 8-10 J.tg/ml ont ete associes a une
incidence elevee d'ototoxicite; de merne, des "creux" supe-
rieurs a 2-3 J.tg/ml ont-ils ete incrimines dans l'etiologie de
reactions nephrotoxiques a cet antibiotique. Malgre l'abon-
dante documentation consacree a cet agent chirniotherapeu-
tique, il demeure encore difficile a l'heure actuelle d'instaurer
 GENTAMICIN DOSAGE

un regime posologique a la fois efficace et non toxique. Pour
ces raisons, un monitorage pharmacocinetique circonspect,
base sur la mesure des taux seriques maximaux et minimaux
du medicament, represente actuellement la therapeutique de
choix chez les malades severement atteints.
Les auteurs presentent ici une breve revue des proprietes
pharmacocinetiques de la gentamicine pertinentes a une utili-
sation clinique. Une serie de cas cliniques illustrent cette
pratique.
ALAIN BOISVERT
References
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Med 1978;89:528-38.
2. Schentag JJ, Jusko WJ, Vance JW, et al. Gentamicin
disposition and tissue accumulation on multiple dosing.
J Pharmacokinet Biopharm 1977;5:559-77.
3. Kaye D, Levison ME, Labovitz ED. The unpredict-
ability of serum concentrations of gentamicin: pharmaco-
kinetics of gentamicin in patients with normal and abnormal
renal function. J Infect Dis 1974;130:150-4.
4. Hull JH, Sarubbi FA. Gentamicin serum concentra-
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10. Dahlgren JG, Anderson ET, Hewitt WL. Gentamicin
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12. Sawchuk RJ, Zaske DE. Pharmacokinetics of dosing
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Revised & Updated, July 1981 Third Edition

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P.O. BOX 42442 if not prepa id)
TABLE OF CONTENTS Pre payme nt is requ ired
CINCINNATI, OH 45242 for individual orders.
I. General Principles - Therapeutic Use
2. General Principles - Adve rse Effects Send cop ies at $9.50 each of PSYCHOTROPIC DRUG
3. Antipsychotics HANDBOOK to :
4. Antidepressants Name
5. Lithium
6. Ant ianxiety Agents Address _
7. Hypnot ics
8. Analgesics
9. Agents for Treating Extrap yram idal Side Effects
10, Disulfiram City
I I. Drug Interac tions Stat e/Co unt ry Zip, _
12. Management and Treatment of Drug Overdosage
13. Management of Withd rawa l o payment enclose d; 0 please bill
14. Amyta l Interv iew o VISA 0 Master Card
15, Electroconvulsive Therapy Exp . dat e, _ Signat ure _
16, Patient Instructions
Acct .
No .
204 pages, soft cover

Drug Intelligence and Clinical Pharmacy VOL 15 SEPT 81 655

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