Aminoglycosides
                                ===============

þ Aminoglycosides are notorious for causing increased weakness in
  patients with myasthenia gravis.
  Reference:  Tintinalli 3rd ed. p 824

þ Aminoglycoside Dose for Critically Ill Patients:

 - Due to increased volume of distribution in critically ill patients, must
   increase loading dose to get expected levels (most studies based on stable
   patients):  per Dr. Edward Rotheram, ID, AGH

 - Recommended loading doses:
   gentamicin/tobramicin:  3mg/kg
   amikacin:  9mg/kg.
   Will produce peak levels of 6mg/L and 30 mg/L.  No increased toxicity with
   this.  [Watling SM, et al.  Aminoglycoside dosing considerations in
   intensive care unit patients.  Ann Pharmacother 1993; 27(3):351.]

þ Once-Daily dosing:
 - once-daily dosing is as effective and less nephrotoxic [Scientific American
   Medicine, December 1995, 10:VI Acute Renal Failure:p.13.]
 - "Conventional administration of aminoglycosides to patients with normal
   renal function has depended on divided doses administered at eight- to
   12-hour intervals.  However, clinical trials demonstrate that in patients
   with normal renal function, once-daily aminoglycoside dosing is as
   effective as traditional divided-dose regimens. Except in the elderly,
   once-daily dosing also has a lower risk of toxicity.  Once-daily dosing has
   not yet been studies adequately in immunocompromised patients, children,
   pregnant women, or in patients with renal dysfunction, burns, ascites, or
   endocarditis."
   [Hatala R, Dinh T, Cook DJ: Once-daily aminoglycoside dosing in
   immuncompetent adults: A meta-analysis.  Ann Intern Med 124:717, 1996.]
   Above showed dosages of

   Gentamicin:  3-4 mg/kg daily

   Amikacin:  11-16 mg/kg daily

   Netlimicin: 4-6.6 mg/lg daily

   [Barza M, Ionnidis JPA, Cappelleri JC, et al. Single or multiple daily
   doses of aminoglycosides: a meta-analysis. BMJ 321:338, 1996.]
   Above did not give dosages for the trials.