[Once-daily gentamicin dosing versus thrice-daily dosing in infants with acute pyelonephritis]

Area of Science:

• Pediatric infectious diseases
• Pharmacokinetics and pharmacodynamics
• Antibiotic dosing strategies

Background:

• Gentamicin once-daily dosing (ODD) is standard for adults with Gram-negative infections.
• Limited data exist on ODD gentamicin efficacy and safety in infants.
• Acute pyelonephritis is a common pediatric urinary tract infection.

Purpose of the Study:

• To compare the efficacy of once-daily (ODD) gentamicin versus thrice-daily (t.i.d.) gentamicin in infants with acute pyelonephritis.
• To evaluate safety parameters including renal function and adverse events.
• To assess pharmacokinetic differences between ODD and t.i.d. gentamicin regimens.

Main Methods:

• A quasi-experimental study comparing 33 infants receiving ODD gentamicin to 25 infants treated with t.i.d. gentamicin (historical controls).
• Analysis included clinical parameters (fever duration, outcome) and laboratory values (leukocytosis, C-reactive protein, creatinine, gentamicin peak/trough levels).
• Dosing, peak, and trough serum gentamicin concentrations were analyzed.

Main Results:

• Higher mean gentamicin doses were used in the t.i.d. group (6.4 mg/kg/day) compared to the ODD group (5.06 mg/kg/day).
• Peak serum gentamicin concentrations were significantly higher in the ODD group (9.32 µg/mL) versus the t.i.d. group (5.09 µg/mL).
• Trough concentrations were lower in the ODD group (0.23 µg/mL) than the t.i.d. group (0.78 µg/mL); fever resolution and renal function were similar, with good outcomes and no adverse events in either group.

Conclusions:

• Once-daily gentamicin dosing is as effective as thrice-daily dosing for infants with acute pyelonephritis.
• ODD gentamicin demonstrated favorable pharmacokinetic profiles with high peak and low trough concentrations.
• ODD gentamicin appears to be a safe and potentially safer alternative for treating Gram-negative infections in infants.