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Once daily dosing of gentamicin in infants and children
1Pediatric Department, Ha'Emek Medical Center, Afula, Israel.
Insights
Once daily dosing (ODD) of gentamicin in children is a cost-saving strategy that appears more effective and as safe as standard daily dosing (SDD). This review supports ODD for pediatric gentamicin therapy.
Area of Science:
- Pediatric Pharmacology
- Infectious Diseases
- Pharmacokinetics
Background:
- Aminoglycosides, including gentamicin, are common in pediatric care.
- Current standard daily dosing (SDD) involves multiple daily administrations.
- Evidence for once daily dosing (ODD) in children requires review.
Purpose of the Study:
- To review existing data on the safety and efficacy of gentamicin ODD in pediatric patients.
- To compare ODD with SDD in terms of pharmacokinetic indices and toxicity.
Main Methods:
- A comprehensive Medline search was performed.
- Included studies compared ODD and SDD of gentamicin in children.
- Focused on pharmacokinetic parameters and adverse events.
Main Results:
- 13 studies on pediatric gentamicin ODD were reviewed.
- ODD generally resulted in higher peak serum concentrations but lower trough concentrations.
- ODD showed a longer half-life (t1/2) and was found to be cost-saving.
- Efficacy was comparable between ODD and SDD in some studies.
Conclusions:
- Gentamicin ODD may be more efficacious than SDD in children.
- ODD does not appear to increase toxicity compared to SDD.
- ODD is a viable alternative for gentamicin therapy in neonates and older children.
Background:
Aminoglycosides are frequently used in children. The standard daily dosing (SDD) in infants and children is twice or three times daily depending on age. The aim of this paper is to review the current data regarding the safety and effectiveness of once daily dosing (ODD) of gentamicin in children.
Methods:
A Medline search was conducted for comparison studies between ODD and SDD of gentamicin in children in term of pharmacokinetic indices and toxicity.
Results:
Overall 13 studies describing ODD of gentamicin in children were found suitable for this review. In most studies steady state peak serum gentamicin concentrations were significantly higher in the ODD groups. Steady state trough concentrations >2 microg/ml were documented in 5 to 55% of patients treated with the SDD as compared with 0 to 24% in the ODD groups. The mode of dosing did not affect the volume of distribution; however, the t1/2 was significantly longer in the ODD groups. ODD was found to be cost-saving. In a few studies the efficacy of ODD was similar to that of SDD.
Conclusions:
These studies suggest that ODD compared with SDD of gentamicin is theoretically more efficacious and has no higher toxicity at 48 to 96 h in neonates and at 3 to 10 days of therapy in older infants and children.