Chronopharmacokinetics of once daily dosed aminoglycosides in hospitalized infectious patients

Int J Clin Pharm. 2015 Apr;37(2):342-7. doi: 10.1007/s11096-015-0066-7. Epub 2015 Jan 24.


Background: hospitalized patients with serious infections treated with aminoglycosides are at risk of developing nephrotoxicity. Previous clinical studies have shown that the pharmacokinetics of aminoglycosides in humans follow a circadian rhythm. Therefore, the time of administration could have important clinical implications with respect to the risk of developing aminoglycoside-associated nephrotoxicity in patients treated with once daily dosing regimens.

Objective: To examine the effect of the time period of administration on aminoglycoside exposure and the incidence of nephrotoxicity in a large population of hospitalized patients with serious infections.

Setting: General ward and intensive care unit of a teaching hospital.

Method: In this retrospective cohort study, patients treated with intravenous tobramycin or gentamicin were eligible for inclusion. Patients were divided into three groups by time of administration: morning, afternoon and night.

Main outcome measure: Pharmacokinetic parameters and the incidences of nephrotoxicity were compared between the morning, afternoon and evening groups. Results 310 general ward and 411 intensive care unit patients were included. No significant differences were found in patient characteristics between the morning, afternoon and night groups. The time period of administration did not affect aminoglycoside pharmacokinetics or the incidence of nephrotoxicity.

Conclusion: The time of administration has no effect on the pharmacokinetics or nephrotoxicity of once daily dosed aminoglycosides in hospitalized patients. Consequently, we advise aminoglycosides to be administered as soon as possible in case of (suspected) severe hospital-acquired infections and subsequent dosages to be based on therapeutic drug monitoring to optimize the efficacy/toxicity balance.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aminoglycosides / administration & dosage*
  • Aminoglycosides / adverse effects
  • Aminoglycosides / pharmacokinetics*
  • Chronopharmacokinetics*
  • Cohort Studies
  • Communicable Diseases / drug therapy*
  • Communicable Diseases / metabolism*
  • Drug Administration Schedule
  • Female
  • Hospitalization* / trends
  • Humans
  • Kidney Diseases / chemically induced
  • Kidney Diseases / metabolism
  • Male
  • Middle Aged
  • Retrospective Studies


  • Aminoglycosides