Aminoglycoside dosing in patients by kidney function and area under the curve: the Sawchuk-Zaske dosing method revisited in the era of obesity

Initial dose selection of antimicrobials typically involves the clinical integration of covariates of drug disposition such as age, sex, weight, and kidney function. However, dynamic clinical states and unaccountable confounders necessitate our measurement of systemic concentrations in an individual patient to better inform dose modification. Over the past 50 years, several research groups have formulated weight- and kidney function–based dosing algorithms to measure, assess, and optimize the dosing of aminoglycosides. The lessons learned from older aminoglycosides may be useful and have applications to newer antimicrobials that are dosed on weight and kidney function. This is especially true among obese patients, for whom optimal dosing algorithms have not been well defined. The purpose of this review is to provide healthcare providers a historical perspective of aminoglycoside therapeutic drug monitoring followed by an updated approach to improve dosing of these agents in obese adult patients.