title: Routine monitoring of gentamicin serum concentrations in pediatric patients with normal renal function is unnecessary.
abstract: 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.
authors.affiliation: Cook Children's Medical Center, Fort Worth, TX 76104, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Logsdon
authors.forename: S J
authors.initials: SJ
authors.lastname: Phelps
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D003404:Creatinine