▸ Higher peak concentrations lead to more rapid and higher (initial) bacterial kill

▸ Toxicity is not increased because aminoglycoside uptake in the kidney and ear is saturable

▸ Higher peaks prolong ‘postantibiotic’ effect (continued suppression of bacterial growth after drug administration stops and serum concentrations are below the minimum inhibitory concentration)

▸ Lower predose concentrations reduce toxicity9

▸ Longer ‘drug-free’ periods help reduce/reverse adaptive resistance (form of resistance developing after initial exposure of bacteria to aminoglycoside)10

▸ If drug clearance is high, ‘no-drug’ (untreated) periods between doses could result in clinically significant bacterial regrowth10

▸ Standard once-daily doses, high doses should be avoided in children over 1 month of age with creatinine clearance <20 mL/min/1.73 m²

▸ More appropriate for burns patients (burns covering >20% of total body surface area) due to excess fluid loss and other complicating factors, and for children with endocarditis3

▸ Not appropriate for patients with reduced renal function (creatinine clearance <20 mL/min/1.73 m²), or neonates, due to insufficient time between doses to clear the drug3

▸ More time-consuming and costly in clinical practice