In a patient receiving gentamicin for sepsis, how can the peak and trough serum concentrations be adjusted for optimal dosing?

The optimal dosing of gentamicin, an aminoglycoside antibiotic, is guided by the principles of pharmacokinetics, particularly regarding peak and trough serum concentrations. When considering how to adjust dosing, it is essential to manage the balance between achieving effective drug levels and minimizing toxicity.

Gentamicin dosing often needs to be tailored based on the patient's renal function and the therapeutic goals. In scenarios where the goal is to maintain therapeutic effectiveness while minimizing the risk of nephrotoxicity and ototoxicity, adjusting the frequency of administration can be critical.

By reducing the frequency without changing the dose, the peak concentrations would decrease, potentially lowering the risk of toxicity. Meanwhile, the trough concentrations could also stabilize within a desired range, allowing for effective antimicrobial activity while ensuring the levels do not accumulate to harmful degrees. This approach is particularly beneficial in patients with impaired renal function, where prolonged drug clearance could lead to increased trough levels, posing a risk for adverse effects.

In contrast, increasing the dose while keeping the frequency constant could result in excessively high peak concentrations, increasing the likelihood of toxic effects. Increasing both the dose and frequency poses similar risks, moving the serum levels beyond the safety threshold. Alternatively, reducing the dose while increasing frequency could decrease efficacy, risking