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Wide Interpatient Variations in Gentamicin Dose Requirements for Geriatric Patients
Darwin E. Zaske, PharmD;
Patrick Irvine, MD;
Linda M. Strand, PhD, PharmD;
Richard G. Strate, MD;
Robert J. Cipolle, PharmD;
John Rotschafer, PharmD
JAMA. 1982;248(23):3122-3126.
Abstract
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Substantial interpatient variations were demonstrated in the daily doses required to obtain therapeutic gentamicin sulfate serum concentrations in 417 elderly patients. Dosages ranged from 0.3 to 22.0 mg/kg/day in patients with a normal serum creatinine level. Twenty-five percent of these patients required daily doses higher than the standard regimen of 5 mg/kg/day, and 33% required less than 3 mg/kg/day. The drug half-lives in these patients ranged from 0.3 to 32.7 hours, compared with previous reports of 2.5 to four hours. The distribution volumes of these patients ranged from 0.07 to 0.53 L/kg, compared with reported values of 0.20 to 0.25 L/kg. These wide variations in kinetic variables in elderly patients and the need to obtain narrow ranges in serum concentrations required measuring serum concentrations and individually calculating each patient's dosage requirement early in the treatment course. Doing this consistently produced optimal peak and trough serum levels. Ototoxicity did not occur in any of the patients, and nephrotoxicity may have been drug related in 2% of the elderly patients.
(JAMA 1982;248:3122-3126)
Author Affiliations
From the College of Pharmacy (Drs Zaske, Strand, Cipolle, and Rotschafer) and the Departments of Surgery (Drs Zaske and Strate) and Medicine (Dr Irvine), School of Medicine, University of Minnesota at St Paul-Ramsey Medical Center.
Footnotes
Reprint requests to St Paul-Ramsey Medical Center, 640 Jackson St, St Paul, MN 55101 (Dr Zaske).
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