Extended interval dosing of gentamicin in premature neonates ≤ 28-week gestation.
OBJECTIVE
To evaluate an extended interval dosing (EID) regimen of gentamicin in neonates ≤28-week gestation.


METHODS
In 2008, an EID regimen for gentamicin was introduced for all neonates admitted to the NICU in Calgary. The dosing interval was based on a 22 h level after the first dose of 5mg/kg. We conducted an observational study in 33 infants ≤28-week gestation on the EID regimen from the first day of life and compared gentamicin peak and trough levels with a historical control of 34 infants who received gentamicin in a dose of 2.5 mg/kg every 24 h (TID, traditional interval dosing).


RESULTS
In the EID group, based on the 22 h level, dosing interval was 36 h in 20 neonates and 48 h in 13 neonates. All neonates, except one, achieved therapeutic peak and trough levels. Compared to the TID group, the EID group had higher peak levels (median 9.8 μg/mL vs. 4.6 μg/mL, p < 0.001) with no difference in trough levels. With target peak levels of 5-12 μg/mL and trough levels of <2 μg/mL, a higher proportion of neonates in the TID group would need dose adjustment.


CONCLUSIONS
In neonates ≤ 28-week gestation, an EID regimen from day one of life, using a single level 22 h after the first dose for dosing interval, achieves therapeutic peak and trough levels and more optimum peak levels as compared to a TID regimen.
Division of Neonatology, Department of Pediatrics, Faculty of Medicine, University of Calgary, Alberta, Canada.
Belal
B
Alshaikh
Deonne
D
Dersch-Mills
Richard
R
Taylor
Albert R
AR
Akierman
Kamran
K
Yusuf
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005839:Gentamicins