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Failure to adjust doses may contribute to adverse events. We evaluated the effectiveness of providing the estimated glomerular filtration rate on appropriateness of dosing for antimicrobials. The approach increased appropriateness of dosing from 33.9% to 41.4% (P < .001). Nudging prescription behavior can boost strategies for adequate antimicrobial prescription.

Discrimination against the binding of noncognate aminoacyl (aa)-tRNAs by mRNA-programmed ribosomes is the outcome of two selection steps, one involving an aa-tRNA.EFTu.GTP complex, which occurs prior to and includes GTP hydrolysis, the other involving the aa-tRNA alone, which follows GTP hydrolysis. Conditions which lead to errors in protein synthesis have been found to influence the accuracy of one or both selection steps in a system measuring poly(U)-directed binding of Leu-tRNA2Leu. Streptomycin has a large effect only on the discrimination process following GTP hydrolysis, but the other pertubations of recognition studied, high [Mg2+], polyamines, the strA1 and ram1 mutations, affect both discrimination processes. The general result is consistent with the view that proofreading of aa-tRNA by ribosomes for the most part uses the same specificity determinants used in the initial selection of a ternary complex.

The characteristics of a GTPase reaction between poly(U)-programmed ribosomes, EFTu . GTP, and the near-cognate aminoacyl (aa)-tRNA, Leu-tRNA Leu 2, have been studied to assess the role of this reaction in proofreading of the codon-anticodon interaction. The reaction resembles the GTPase reaction with cognate aa-tRNAs and EFTu . GTP in its substrate requirements, in its involving EFTu . GTP . aa-tRNA ternary complexes, and in its requiring a free ribosomal A-site. The noncognate reaction differs from the cognate one in that aa-tRNA becomes stably bound to the ribosomes only 5% of the time; it therefore seems best characterized as an abortive enzymatic binding reaction. The rate of reaction is a significant fraction (4%) of that of the cognate aa-tRNA, indicating that recognition of ternary complexes by ribosomes involves a level of error greater than that of translation as a whole. The rejection of the noncognate aa-tRNA following GTP hydrolysis is therefore a vital step in the translation process and fulfills the criteria set for a proofreading reaction. Leu-tRNA Leu 2 which escapes rejection through proofreading, forms a stable complex with the ribosomal A-site, so it appears that the Leu-tRNA2 which was rejected never reached the A-site and that proofreading precedes full A-site binding.