胺基醣苷類抗生素具有藥效相關的動力學特性,包含:濃度依賴的殺菌效果、抗生素後效應及調適性抗藥性。依據這些特性而有學者倡導以高劑量、低頻次的給藥方式,期望能達到最大療效及減少毒性反應,通稱為once-daily dosing或extended-interval dosing。在使用胺基醣苷類抗生素可能產生的副作用包括有腎毒性、耳毒性及神經肌肉阻斷等。傳統的每日多次使用所產生腎毒性的相關危險因子已被確認,包含老年人,肝、腎功能不良,使用的藥品種類、劑量、頻次、治療時間及同時使用具有腎毒性的藥品。本文係以老年族群為對象,藉由文獻回顧討論使用每日一次胺基醣苷類抗生素導致腎毒性及其相關的危險因子。結果顯示:目前尚無足夠的證據支持每日一次的給藥方式會增加腎毒性,反之,也無足夠的證據支持其不會增加腎毒性。因此,就目前的文獻基礎建議,老人使用每日一次的胺基醣苷類抗生素時,需注意其本身的腎功能,劑量宜降低,治療期間建議少於一週。當併服其他具有腎毒性的藥品或同時有其他危險因子存在時,更須密切監測其發生腎毒性的可能。
Aminoglycosides are capable of demonstrating concentration-dependent bactericidal activity, post antibiotic effect PAE, and adaptive resistance against susceptible organisms. Once-daily or extended-interval aminoglycoside dosing was accordingly developed to utilize these properties. It is believed that once-daily aminoglycoside (ODA) dosing can achieve maximal bactericidal activity without increasing the risk of nephrotoxicity. Yet use of the ODA regimen in elderly patients remains controversial since advanced age has long been regarded as an important risk factor in the development of aminoglycoside-associated nephrotoxicity. In previous studies, several risk factors for nephrotoxicity in the elderly have been well established. In prescribing once-daily aminoglycosides for elderly patients, we should assess its safety by carefully evaluating possible risk factors for nephrotoxicity.