title: Gentamicin in neonatal infection: once versus twice daily dosage.
abstract: Fifty-four neonates were included and completed the study. Twenty-seven neonates were given 2.0-2.5 mg/kg of gentamicin twice daily while 27 neonates were given 4.0-5.0 mg/kg of gentamicin once daily. The twice daily dose and the once daily dose group had mean steady state gentamicin peak concentrations of 5.94 +/- 1.57 mg/l and 8.92 +/- 1.59 mg/l, respectively (p<0.05) while their trough concentrations were 1.44 +/- 0.49 mg/l and 0.90 +/- 0.35 mg/l, respectively (p<0.05). There were 3 neonates (11.11%) in the twice daily dose group whose peak and trough level were not within the desirable therapeutic range, two patients with too high trough level (>2 mg/l) and one with subtherapeutic peak level (<4 mg/l). Only one patient in the once daily group had undesirable trough level that was higher than 1.5 mg/l but less than 2 mg/l. Treatment with a once daily dose did not present more nephrotoxity than a twice daily dose regimen and had the tendency to have less effect on renal function. Once daily dosage can achieve the equivalent efficacy compared to a twice-daily dosage regimen. All neonates in twice daily and once daily dosage groups showed improvement in clinical outcome. Therefore, a once daily dose of gentamicin with 4.0-5.0 mg/kg could be an appropriate regimen in term neonates during the first 7 days of life. This regimen produces peak concentration that may have greater clinical efficacy and trough concentration with less toxicity than conventional dosing regimen.
authors.affiliation: Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
authors.forename: U
authors.initials: U
authors.lastname: Chotigeat
authors.forename: A
authors.initials: A
authors.lastname: Narongsanti
authors.forename: D P
authors.initials: DP
authors.lastname: Ayudhya
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D001424:Bacterial Infections / Q000097:blood / Q000188:drug therapy*; D001835:Body Weight; D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced; D008297:Male; D008657:Metabolic Clearance Rate; D011446:Prospective Studies; D013785:Thailand; D013810:Therapeutic Equivalency; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D003404:Creatinine