[Once-daily gentamicin dosing versus thrice-daily dosing in infants with acute pyelonephritis].
BACKGROUND
Once-daily dosing (ODD) of gentamicin is advocated as an effective and safe treatment of Gram-negative bacterial infections in adults. There are insufficient data in the literature to justify its use in infants.


OBJECTIVE
To compare the efficacy of ODD of gentamicin with that of classical thrice-daily (t.i.d.) administration in infants with acute pyelonephritis.


METHODS
We performed a quasi-experimental study comparing 33 infants who received ODD of gentamicin with a historical control group of 25 infants treated with gentamicin t.i.d. Leukocytosis, C-reactive protein, creatinine, gentamicin dose, peak and trough values, time required for disappearance of fever, and outcome were analyzed.


RESULTS
The mean doses of gentamicin (mg/kg/day) were higher in the t.i.d. group (6.4 1.14) than in the ODD group (5.06 0.22; p < 0.001). Peak serum gentamicin concentrations (micro g/ml) were significantly higher in the ODD group (9.32 1.4) than in the t.i.d. group (5.09 1.15; p < 0.001). Mean trough gentamicin concentrations (micro g/ml) were lower in the ODD group than in the t.i.d. group (0.23 0.26 vs 0.78 0.45; p 0.001). There were no significant differences in the duration of fever between the groups (30.64 32 hours in the t.i.d. group vs. 28.57 32 hours in the ODD group). Serum creatinine levels were normal during treatment in both groups. In all patients outcome was good and no adverse effects were noted.


CONCLUSIONS
Treatment with ODD of gentamicin in our population of infants with acute pyelonephritis was as effective as traditional administration t.i.d. and possibly was equally safe or safer.
Calvo Rey
C
C
Servicios de Pediatría (Unidad de Lactantes), Hospital Severo Ochoa. Madrid. España. ccalvo@mi.madritel.es
García Díaz
B
B
Nebreda Pérez
V
V
García García
M L
ML
Maderuelo Sánchez
A I
AI
Cilleruelo Pascual
M L
ML
García Lacalle
C
C
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D008297:Male; D011704:Pyelonephritis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D005839:Gentamicins