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To the Editor.—
Gentamicin sulfate administered to patients with renal failure at intervals between doses as recommended by Shubin and Weil (235:421, 1976) leads to serum levels below 1μg/ml (Ann Intern Med 74:192, 1971), which could persist for long periods if renal function improves before the next dose. We recently treated such a patient with traumatic bowel perforation and a creatinine level of 7.5 mg/100 ml with a maintenance dose of 30 mg every eight hours the first day. This was increased to 50 mg by the fourth day because the creatinine level had decreased to 5.1 mg/100 ml. Using the schedule shown by Shubin and Weil, the patient would not have received gentamicin for four full days after his initial loading dose. I believe Chan's nomogram for giving a reduced dose of gentamicin every eight hours (Ann Intern Med 76:773, 1972) allows for better control of serious infection by
Minuth JN. Management of Bacterial Shock. JAMA. 1976;236(7):819–820. doi:10.1001/jama.1976.03270080011004
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