Aminoglycosides for life-threatening infections: a plea for an individualized approach using intensive therapeutic drug monitoring.

Aminoglycosides are potent antibiotics with a renewed interest due to the increase in multidrug resistant infections. Their use in life-threatening infections ‑ in combination with other antibiotics ‑ has been debated due to the lack of clear outcome benefits. However, based on recent pharmacokinetic-pharmacodynamic studies, conventional dosing may be inefficient in a considerable number of patients, which could preclude the efficiency of this potent drug class. Toxicity on the other hand remains a concern, with nephrotoxicity as the most relevant negative effect in the critically ill. Short term, intensively monitored treatment strategies - with monitoring both peak and trough levels - may increase efficacy as well as reduce toxicity in the critically ill patient.