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This study was aimed to compare with previous results (Grillot et al., 1994), the efficacy of amikacin adaptive optimal control in a geriatric hospital.Patients – During six months, 32 patients (aged of 82 ± 8 years) were included versus 51 during two years (aged of 80 ± 5). The mean age was not different between the two populations (NS, Student test). They received amikacin initial dosage of 17.7 ± 5.1 mg/kg/d (vs 13.3 ± 3.5 for the reference study) and maintenance dosage of 15.1 ± 4.8 mg/kg/d (vs 11.8 ± 5.1 for the reference study).Method – Two efficacy outcomes (E1 and E2) and 1 toxicity outcome (T) were taken into account: E1 estimated the effect of adaptive control on maximal drug level, E2: overall recovery. Toxicity outcome was used: T the nephrotoxicity (increasing creatinine´mia over 44 μmol/l).Results – All the results are given versus the reference study. 57.6% versus 29.4% of adaptive strategy were once-a-day. E1: Chi square test show that initial dosage and maintenance dosage are greater our study than the previous one (p < 0.05: 78.8% versus 5.9% for initial dosage, 84.4% versus 13.8% for maintenance dosage). E2: 73.6% overall of recovery versus 77% (NS, Chi square test). T: 94% versus 85% (p < 0.05, Chi square test) of creatininemia variation are lower than 44 μmol/l. Duration of treatement is 9.8 ± 4.8 versus 15 ± 9 days (p < 0.5, Student test).Conclusions – Once-a-day strategy in amikacin therapeutic regimen is no more efficient but decreases toxicity and duration treatment. [Copyright &y& Elsevier]