Treatment of urinary tract infection with gentamicin once or three times daily.
OBJECTIVE
To examine the safety and efficacy of once-daily (OD) gentamicin treatment compared with conventional 8-hourly dosing (TDS) for urinary tract infection (UTI).


METHODS
This was a prospective, randomized, controlled trial of children 1 mo to 13 y of age with presumed UTI. Children were randomly assigned to OD gentamicin 5 mg kg(-1) d(-1) or TDS gentamicin 6 mg kg(-1) d(-1) divided 8 hourly. Microbiological efficacy, nephrotoxicity, ototoxicity and renal scarring were assessed at the end of treatment.


RESULTS
210 patients with presumed UTI were recruited, of whom 172 were analysable (OD 84, TDS 88). The median age was 7 mo, 50% were male and 74% (n = 127) of patients had pyelonephritis. The majority of infections were due to Escherichia coli (n = 153, 89%), of which 9 (5.2%) were bacteraemic. Comparing the two groups, there was no significant difference in age, gender, duration of fever before admission, pyuria, nitrite positivity or initial total white blood cell count. All patients had negative urine cultures after 2-3 d of treatment, demonstrating 100% microbiological efficacy. There was no difference between the two groups in terms of ototoxicity, nephrotoxicity, duration of gentamicin treatment or time to fever defervescence.


CONCLUSIONS
OD gentamicin is as efficacious as TDS gentamicin in the treatment of UTI in children, with no difference in ototoxicity and nephrotoxicity.
Chong
C Y
CY
Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore. cychong@kkh.com.sg
Tan
A S L
AS
Ng
W
W
Tan-Kendrick
A
A
Balakrishnan
A
A
Chao
S M
SM
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004427:Ear Diseases / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D005839:Gentamicins / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology
D000900:Anti-Bacterial Agents; D005839:Gentamicins