A multicenter evaluation of gentamicin therapy in the neonatal intensive care unit.
OBJECTIVE
To evaluate traditional nomogram (TN) versus individualized pharmacokinetic gentamicin dosing practices in neonatal intensive care units, focusing on achieving target therapeutic concentrations (peak > 8 microg/ml, trough < 2 microg/ml), number of dosing changes, number of concentrations obtained, and evidence of nephrotoxicity.


METHODS
Retrospective chart review.


METHODS
Three neonatal intensive care units.


METHODS
Three hundred nine infants prescribed gentamicin.


METHODS
None.


RESULTS
Sixty-seven percent of patients receiving pharmacokinetic dosing had initial peak concentrations of 8 microg/ml or greater compared with 7% of patients receiving TN dosing (p<0.001). Trough concentrations exceeding 2 microg/ml were reported in 23% of patients receiving TN dosing compared with 2% of pharmacokinetic-dosed patients (p<0.001). Forty-two percent and 6%, respectively, required dosage adjustments (p<0.01). The mean number of concentrations obtained per patient was 2.8 and 2.1, respectively (p<0.01). Neither group had evidence of gentamicin-related nephrotoxicity.


CONCLUSIONS
Compared with TN dosing, administering gentamicin loading doses and performing initial pharmacokinetic analysis resulted in rapid attainment of desired concentrations and fewer dosage adjustments, and allowed for a decrease in the number of gentamicin concentrations.
Glover
M L
ML
College of Pharmacy, Nova Southeastern University, Ft. Lauderdale, Florida, USA.
Shaffer
C L
CL
Rubino
C M
CM
Cuthrell
C
C
Schoening
S
S
Cole
E
E
Potter
D
D
Ransom
J L
JL
Gal
P
P
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005839:Gentamicins / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007674:Kidney Diseases / Q000139:chemically induced; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D005839:Gentamicins