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Once-Daily Gentamicin Dosing of 4 Mg/Kg/Dose in Neonates


Pakaphan Kiatchoosakun, MD*,
Pope Kosalaraksa, MD*, Junya Jirapradittha, MD*,
Sukanya Taksaphan, MD*, Sompon Tassniyom, MD*

* Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen


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 g/mL). The authors studied 105 neonates (of > 34 wk gestational age 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) g/mL, respectively. The peak serum concentration achieved a therapeutic level > 4 g/mL in 102 neonates (97%), while 7 (6.67%) had an undesirable trough level (viz. > 2 g/mL); notwithstanding, no nephrotoxic or ototoxic effects were identified. Gentamicin once-daily at 4 mg/kg/dose in neonates at > 34 wk gestation achieved appropriate trough levels: the regimen was convenient and did not increase renal or ototoxicity.

Keyword : Once-daily, Gentamicin, Neonate

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