title: Once-daily gentamicin dosing of 4 Mg/Kg/dose in neonates.
abstract: Since gentamicin is one of the most commonly prescribed antibiotics for culture-proven or suspected sepsis in neonates, interest has increased in refining dosing regimens for improved efficacy and decreased toxicity. Usually, 2.5 mg gentamicin/kg is infused twice daily, but its large volume of distribution, slow renal clearance and concentration-dependent character, suggests longer dosing intervals would be more appropriate. From a previous study, 22% of neonates who received a once-daily gentamicin dosage of 5 mg/kg/day had unacceptably high trough levels (i.e. > 2 microg/mL). The authors studied 105 neonates (of > or = 34 wk gestational age or > or = 2, 000 g body weight) admitted to the Neonatal Unit, Srinagarind Hospital, Khon Kaen University; at risk, or with clinical features of sepsis, receiving a once-daily gentamicin dosing of 4 mg/kg intravenously. Peak (i.e. efficacy) and trough (i.e. toxicity) serum gentamicin concentrations were collected on day 3 of therapy. On days 1 and 3, nephrotoxicity was evaluated from serum creatinine and ototoxicity by a hearing test. Neonates treated with 4 mg gentamicin/kg once-daily had a mean steady-state peak vs trough concentration of 7.33 (+/- 2.77) vs 0.99 (+/- 0.57) microg/mL, respectively. The peak serum concentration achieved a therapeutic level > 4 microg/mL in 102 neonates (97%), while 7 (6.67%) had an undesirable trough level (viz. > 2 microg/mL); notwithstanding, no nephrotoxic or ototoxic effects were identified. Gentamicin once-daily at 4 mg/kg/dose in neonates at > or = 34 wk gestation achieved appropriate trough levels. the regimen was convenient and did not increase renal or ototoxicity.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Pakaphan
authors.initials: P
authors.lastname: Kiatchoosakun
authors.forename: Pope
authors.initials: P
authors.lastname: Kosalaraksa
authors.forename: Junya
authors.initials: J
authors.lastname: Jirapradittha
authors.forename: Sukanya
authors.initials: S
authors.lastname: Taksaphan
authors.forename: Sompon
authors.initials: S
authors.lastname: Tassniyom
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins