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GENTAMICIN: Single Daily Dose
- Dr.Ranabir Pal (5 February 2008)
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Dr.Ranabir Pal, Associate Professor, Community Medicine Sikkim-Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, Sikkim, India,Post 737102
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From: Dr. Ranabir Pal, Associate Professor, Community Medicine, Sikkim-Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, Sikkim, India .737102 Contact no: +91 94332 47676 E-mail id: ranabirmon@yahoo.co.in ranabirmon@rediffmail.com ranabirmon@gmail.com To, The Editor, Journal of Tropical Pediatrics jnls.cust.serv@oxfordjournals.org <jnls.cust.serv@oxfordjournals.org Dear Sir, Since February 1981, as Resident of Paediatric Medicine at Medical College, Calcutta, we had been using Gentamicin as single daily dose intramuscularly for all paediatric critical in-patients, in the pharmacological dose of 5-7 mg per kg body weight, as well as during follow-up management. After discharge as domiciliary advice, we found reasonable and satisfactory outcome without any re-admission as immediate relapse even in serious infections viz. Septicemia, Acute Respiratory infections, Acute Diarrhoea etc. Even on follow-up, the caregivers did not report any adverse situations. After completing residency, during Diploma in Child Health and MD (Community Medicine) training periods at Medical College, Calcutta, we also pursued same protocol with comparable results. Then during my private practice as General Paediatrician, I always pursued single dose daily regimen in all sorts of severe infections for last 25 years till date. As a General Paediatrician working in Calcutta Metro I usually served children from lower middle-class origin, who were usually malnourished (PEM grade-I or more) in OPD settings. Rarely I had scope of admitting them in paid in-patients facilities for better management with costlier drug regimes used parenterally. This relatively cheaper with high compliance antibiotic, namely Gentamicin used intramuscularly, saved my uncountable seriously infected paediatric patients of Septicemia, Severe pneumonia etc in their domiciliary settings combined with or without Oral semi-synthetic Penicillin / Cefalexin analogues(Ampicillin,Amoxycillin, Cefixime etc). Recently, many original research articles have been published on dosage with contradictory findings. Meta-analysis and review articles also tried with varying conclusions on dosage schedules Unfortunately, the question of clinical superiority of single daily dosing versus multiple daily dosing remains unanswered because of a lack of sufficient statistical power in the studies published to date. Combining data from studies using meta-analytical techniques assumes that the differences among studies are due to chance. In addition, the choice of meta-analytic method and selection of data can lead to differing conclusions regarding the safety and efficacy of amino-glycosides. Nevertheless, our goal is to present a review of both multiple and single daily dosing in various patient populations. Despite methodological flaws in the available literature, current evidence would suggest that when single and multiple daily dosing regimens are compared there is no difference in efficacy, and there is a trend toward reduced toxicity with the single regimens1-13. I humbly exchange my experience with my global peers that this cheap as well as effective drug does not have its due respect it deserves. Even in this new millennium in the crowd of newer antibiotics, it has proved its existence as effective one with scattered reports of resistances. In the developing countries, we have to evolve cheaper and innovative drug regimes that can be used safely in domiciliary settings for seriously ill patients who cannot provide for in-patient service as well as costly newer antibiotics. On the top of everything, WHO recently also is thinking in this line to provide cheaper drugs after patent laws will be implemented fully globally. Reference: 1.Luis S. GonzalezIII, Jeanne P. Spencer, Aminoglycosides: A Practical Review, American Family PhysicianŽ > Vol. 58/No. 8 (November 15, 1998) in http://www.aafp.org/afp/981115ap/gonzalez.html retrieved on 17/10/2006 2.Gilbert DN. Once-daily aminoglycoside therapy. Antimicrob Agents Chemother 1991;35:399-405. 3.Prins JM, Weverling GJ, van Ketel RJ, Speelman P. Circadian variations in serum levels and the renal toxicity of aminoglycosides in patients. Clin Pharmacol Ther 1997;62:106-11. 4.Marra F, Partovi N, Jewesson P. Aminoglycoside administration as a single daily dose. An improvement to current practice or a repeat of previous errors? Drugs 1996;52:344-70. 5.Galloe AM, Graudal N, Christensen HR, Kampmann JP. Aminoglycosides: single or multiple daily dosing? A meta-analysis on efficacy and safety. Eur J Clin Pharmacol 1995;48:39-43. 6.Hatala R, Dinh T, Cook DJ. Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis. Ann Intern Med 1996;124:717-25. 7.Ali MZ, Goetz MB. A meta-analysis of the relative efficacy and toxicity of single daily dosing versus multiple daily dosing of aminoglycosides. Clin Infect Dis 1997;24:796-809. 8.Bailey TC, Little JR, Littenberg B, Reichley RM, Dunagan WC. A meta- analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides. Clin Infect Dis 1997;24:786-95. 9.Hatala R, Dinh TT, Cook DJ. Single daily dosing of aminoglycosides in immunocompromised adults: a systematic review. Clin Infect Dis 1997;24:810 -5. 10.Freeman CD, Strayer AH. Mega-analysis of meta-analysis: an examination of meta-analysis with an emphasis on once-daily aminoglycoside comparative trials. Pharmacotherapy 1996;16: 1093-102. 11.Ferriols-Lisart R, Alos-Alminana M. Effectiveness and safety of once- daily aminoglycosides: a meta-analysis. Am J Health Syst Pharm 1996;53:1141-50. 12.Deamer RL, Dial LK. The evolution of aminoglycoside therapy: a single daily dose. Am Fam Physician 1996;53:1782-6. 13.Thomson AH, Duncan N, Silverstein B, Alcock S, Jodrell D. Antimicrobial practice. Development of guidelines for gentamicin dosing. JAntimicrob Chemother 1996;38:885-93. Conflict of Interest: None Funding: None Acknowledge; None With best wishes Dr.Ranabir Pal, e-mail-id:ranabirmon@yahoo.co.in Conflict of Interest:None declared |
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