Prediction of aminoglycoside distribution space in neonates by multiple frequency bioelectrical impedance analysis.
OBJECTIVE
Aminoglycoside antibiotics have a narrow margin of safety between therapeutic and toxic levels. The current study used multiple frequency bioelectrical impedance analysis to develop prediction equations for gentamicin distribution space in neonates.


METHODS
Gentamicin pharmacokinetic parameters and bioimpedance were measured in 14 infants in the neonatal intensive care unit. Stepwise regression analysis was used to develop predictive models, using impedance quotients (F2/R), weight and gestational age as variables, whose predictive performance was then tested in a second group of ten infants.


RESULTS
The prediction model with the smallest bias and highest concordance correlation was that which included F2/R0 and weight. This bias of 50 ml or 6.7% was less than half of that found using a model including weight alone.


CONCLUSIONS
A bioelectrical impedance-based prediction equation for prediction of gentamicin distribution space in neonates was produced. Although this prediction equation represents only a small improvement over that using weight alone, this is of clinical significance due to the narrow margin between therapeutic and toxic levels for gentamicin. A clinical trial to confirm the value of this methodology is now warranted.
Lingwood
B E
BE
Perinatal Research Centre, University of Queensland, Royal Women's Hospital, Brisbane, Australia. LingwoodB@health.qld.gov.au
Coghlan
J P
JP
Ward
L C
LC
Charles
B G
BG
Colditz
P B
PB
D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics*; D001835:Body Weight; D015331:Cohort Studies; D017097:Electric Impedance; D005260:Female; D005839:Gentamicins / Q000493:pharmacokinetics*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn / Q000378:metabolism*; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis; D014018:Tissue Distribution
D000900:Anti-Bacterial Agents; D005839:Gentamicins