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Nephrotoxicity of Common Drugs Used in Clinical Practice-Reply

William M. Bennett, MD
Arch Intern Med. 1988;148(1):237. doi:10.1001/archinte.1988.00380010239028.
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In Reply.  —We appreciate the comments of Forrester and Goldman, and we definitely agree that peak serum levels correlate with therapeutic efficacy of aminoglycosides. In fact, dosing strategies designed to maximize peak levels, even allowing subtherapeutic periods to take advantage of the so-called postantibiotic effect, may combine enhanced therapeutic efficacy with minimization of toxicity.1-3 However, we are not in agreement that pharmacokinetic dosing on an individual basis is necessarily worth the considerable expense involved, at least in terms of preventing nephrotoxicity. The best study in the literature by Matzke et al,4 achieved excellent peak and trough aminoglycoside levels. Yet, even though individualized pharmacokinetic dosing was used, the prevalence of aminoglycoside toxicity was not statistically different from the more conventional McHenry method.3 In view of the current knowledge concerning the importance of renal aminoglycoside handling, independent of serum levels, I doubt that even the most expert pharmacokinetic dosing


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