Once-daily gentamicin dosing of 4 Mg/Kg/dose in neonates.

Kiatchoosakun, Pakaphan; Kosalaraksa, Pope; Jirapradittha, Junya; Taksaphan, Sukanya; Tassniyom, Sompon

Once-daily gentamicin dosing of 4 Mg/Kg/dose in neonates.

Date

2005-07-26

Authors

Kiatchoosakun, Pakaphan

Abstract

Since gentamicin is one of the most commonly prescribed antibiotics for culture-proven or suspected sepsis in neonates, interest has increased in refining dosing regimens for improved efficacy and decreased toxicity. Usually, 2.5 mg gentamicin/kg is infused twice daily, but its large volume of distribution, slow renal clearance and concentration-dependent character, suggests longer dosing intervals would be more appropriate. From a previous study, 22% of neonates who received a once-daily gentamicin dosage of 5 mg/kg/day had unacceptably high trough levels (i.e. > 2 microg/mL). The authors studied 105 neonates (of > or = 34 wk gestational age or > or = 2, 000 g body weight) admitted to the Neonatal Unit, Srinagarind Hospital, Khon Kaen University; at risk, or with clinical features of sepsis, receiving a once-daily gentamicin dosing of 4 mg/kg intravenously. Peak (i.e. efficacy) and trough (i.e. toxicity) serum gentamicin concentrations were collected on day 3 of therapy. On days 1 and 3, nephrotoxicity was evaluated from serum creatinine and ototoxicity by a hearing test. Neonates treated with 4 mg gentamicin/kg once-daily had a mean steady-state peak vs trough concentration of 7.33 (+/- 2.77) vs 0.99 (+/- 0.57) microg/mL, respectively. The peak serum concentration achieved a therapeutic level > 4 microg/mL in 102 neonates (97%), while 7 (6.67%) had an undesirable trough level (viz. > 2 microg/mL); notwithstanding, no nephrotoxic or ototoxic effects were identified. Gentamicin once-daily at 4 mg/kg/dose in neonates at > or = 34 wk gestation achieved appropriate trough levels. the regimen was convenient and did not increase renal or ototoxicity.

Description

Chotmaihet Thangphaet.

Citation

Kiatchoosakun P, Kosalaraksa P, Jirapradittha J, Taksaphan S, Tassniyom S. Once-daily gentamicin dosing of 4 Mg/Kg/dose in neonates. Journal of the Medical Association of Thailand. 2005 Jul; 88(7): 934-8