Gentamicin use in neonates: should we have a change of practice?
BACKGROUND
Gentamicin, one of the most commonly used antibiotics in neonates, has potential toxicity. This study was performed to determine the incidence of potential toxicity of gentamicin in term and preterm neonates.


METHODS
A one-year retrospective study in neonates admitted to Special Baby Care Units at University Hospital of North Durham and Darlington Memorial Hospitals. We reviewed each admission and looked through the case notes in detail to document information about gentamicin administration, dosage and elevated gentamicin levels in the blood. Pre-third dose gentamicin levels >2 mg/L were classified as elevated.


RESULTS
Overall, 192 babies (83 term and 109 preterm) had documented gentamicin levels. Of these, 43% (84/192) manifested elevated gentamicin levels. Of the babies with elevated gentamicin levels, 67% (56/84) weighed less than 2.5 kg. When a combination of gestation period and weight was considered, 61% (51/84) of preterm infants weighing <2.5 kg had elevated levels whereas only one term infant <2.5 kg exhibited elevated levels.


CONCLUSIONS
Preterm neonates and specifically low birth weight neonates tolerate gentamicin poorly. Dosage and/or interval of administration of the medication may need modification in this group to minimise toxicity.
Consultant Paediatrician, KK Women's and Children's Hospital, Singapore.
S S
SS
Krishnamoorthy
A
A
Nair
J
J
Furness
J
J
Sanderson
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000009:adverse effects*; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012606:Scotland; D018805:Sepsis / Q000188:drug therapy / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D005839:Gentamicins
Antibiotic; gentamicin; preterm; toxicity