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Comparison of two gentamicin dosing schedules in very low birth weight infants

Alok Rastogi1, Ghanshyam Agarwal, Suma Pyati

  • 1Department of Pediatrics, Cook County Children's Hospital, Chicago, IL 60612, USA. arastogi1@hotmail.com

The Pediatric Infectious Disease Journal
|May 15, 2002
PubMed

Insights

The 48-hour gentamicin dosing schedule for very low birth weight infants achieved therapeutic levels, but nearly one-third had low concentrations before the next dose. A 36-hour interval may be optimal for gentamicin therapy.

Area of Science:

  • Neonatal Pharmacology
  • Pediatric Infectious Diseases
  • Clinical Pharmacy

Background:

  • Gentamicin dosing in very low birth weight (VLBW) infants is critical for treating sepsis.
  • Existing dosing schedules require evaluation for optimal efficacy and safety in preterm neonates.

Purpose of the Study:

  • To compare the efficacy and pharmacokinetics of two gentamicin dosing schedules in preterm neonates.
  • To evaluate a new every 48 hours (q48h) dosing schedule against the existing every 24 hours (q24h) schedule.

Main Methods:

  • A prospective, randomized controlled trial involving 58 VLBW infants (600-1500 g) treated for suspected sepsis.
  • Infants received either q48h (5.0 or 4.5 mg/kg/dose) or q24h (2.5 or 3.0 mg/kg/dose) gentamicin.
  • Peak and trough serum gentamicin concentrations were monitored.

Main Results:

  • The q48h schedule resulted in significantly higher peak serum gentamicin concentrations (8.19 vs. 6.04 µg/mL) compared to q24h.
  • Ninety percent of q48h infants achieved therapeutic peak concentrations (6-12 µg/mL) versus 55% of q24h infants.
  • While q48h reduced subtherapeutic peaks, 30% of infants had low trough concentrations (<0.5 µg/mL) before the next dose.

Conclusions:

  • The q48h gentamicin schedule achieves therapeutic peaks in VLBW infants but may lead to prolonged periods of low trough concentrations.
  • Nearly one-third of infants on q48h dosing had very low trough levels, potentially impacting efficacy.
  • A 36-hour dosing interval warrants investigation to balance bactericidal activity and minimize prolonged sub-therapeutic levels.
Abstract

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