Pharmacology Notes

The doses recommended in Table 2.25 may be given as a once-daily dose or in 2 or 3 divided doses. For pharmacodynamic and toxicity reasons, once-daily (or less frequent) dosing is now the recommended method in most clinical settings.

Once-daily dosing is not recommended in those with unconventional kinetics (eg patients with burns and others with large volumes of distribution). Although published evidence is limited, once-daily dosing of aminoglycosides is being used with increasing frequency in pregnancy for chorioamnionitis and the initial treatment of pyelonephritis.

Once-daily dosing is not yet widely accepted for the treatment of endocarditis. There have been 2 published studies supporting its use in the treatment of endocarditis caused by penicillin-susceptible viridans streptococci. Thus, this option might be considered in this subset of endocarditis, but once-daily dosing is not recommended at present for endocarditis caused by enterococci or penicillin-nonsusceptible (‘resistant’) streptococci.