Routine monitoring of gentamicin serum concentrations in pediatric patients with normal renal function is unnecessary.
OBJECTIVE
Due to increasing demands for cost containment within the healthcare system, we evaluated the need for routine gentamicin concentrations (i.e., peak and trough with third dose).


METHODS
Single-institution study performed concurrently with hospitalization.


METHODS
A 225-bed pediatric teaching hospital.


METHODS
The study population consisted of 150 hospitalized pediatric patients (53% medicine, 47% surgical patients) from 3 months to 15 years old with normal serum creatinine.


METHODS
If the administered dose produced diagnoses-appropriate peak concentrations of at least 4 micrograms/mL or 5 micrograms/mL in bacteremia/septicemia and at least 6 micrograms/mL or 8 micrograms/mL in patients with pneumonia if trough serum gentamicin concentrations were less than 2 micrograms/mL, if the patient was noted by the attending physician to be clinically responding as well as objectively having a decreased white blood cell count and was afebrile, and if there was not an increase of 0.5 mg/dL or more in serum creatinine during the course of therapy.


RESULTS
Patients received a mean dose of gentamicin 2.51 +/- 0.14 mg/kg i.v. q8h, which resulted in a mean peak concentration of 6.1 +/- 1.7 micrograms/mL (range 2.4-11.7) and a mean trough concentration of 0.5 +/- 0.3 microgram/mL (range 0.1-1.8). Peak and trough concentrations were at least 4 micrograms/mL and less than 2 micrograms/mL in 96% and 100% of patients, respectively. No patient required a dosage change due to lack of clinical response.


CONCLUSIONS
Our data do not support the routine monitoring of gentamicin concentrations in pediatric patients older than 3 months of age who are receiving appropriate standard doses of gentamicin and have normal renal function.
Logsdon
B A
BA
Cook Children's Medical Center, Fort Worth, TX 76104, USA.
Phelps
S J
SJ
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000191:economics / Q000493:pharmacokinetics; D002648:Child; D002675:Child, Preschool; D003363:Cost Control; D003404:Creatinine / Q000097:blood; D016903:Drug Monitoring / Q000191:economics*; D005260:Female; D005839:Gentamicins / Q000097:blood* / Q000191:economics / Q000493:pharmacokinetics; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D003404:Creatinine