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Treatment of urinary tract infection with gentamicin once or three times daily
1Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore. cychong@kkh.com.sg
Insights
Once-daily gentamicin is as effective as 8-hourly dosing for pediatric urinary tract infections (UTI). This dosing strategy shows no increased risk of kidney or hearing damage, offering a safe alternative for treating childhood UTI.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Urinary tract infections (UTI) are common in children.
- Gentamicin is a frequently used antibiotic for UTI.
- Optimal dosing regimens for pediatric UTI require investigation.
Purpose of the Study:
- To compare the safety and efficacy of once-daily (OD) gentamicin versus three-times-daily (TDS) dosing for pediatric UTI.
- To assess microbiological cure, nephrotoxicity, ototoxicity, and renal scarring.
Main Methods:
- Prospective, randomized, controlled trial in children aged 1 month to 13 years with presumed UTI.
- Patients received either OD gentamicin (5 mg/kg/day) or TDS gentamicin (6 mg/kg/day, divided every 8 hours).
- Outcomes included microbiological efficacy, nephrotoxicity, ototoxicity, and renal scarring.
Main Results:
- 172 children were analyzed (84 OD, 88 TDS).
- 100% microbiological efficacy was observed in both groups, with negative urine cultures after 2-3 days.
- No significant differences were found in ototoxicity, nephrotoxicity, treatment duration, or time to fever resolution between OD and TDS groups.
Conclusions:
- Once-daily gentamicin is a safe and effective alternative to conventional 8-hourly dosing for pediatric UTI.
- The OD regimen demonstrates comparable efficacy and safety profiles regarding renal and auditory toxicity.
- This study supports OD gentamicin as a viable treatment option for childhood urinary tract infections.
Aim:
To examine the safety and efficacy of once-daily (OD) gentamicin treatment compared with conventional 8-hourly dosing (TDS) for urinary tract infection (UTI).
Methods:
This was a prospective, randomized, controlled trial of children 1 mo to 13 y of age with presumed UTI. Children were randomly assigned to OD gentamicin 5 mg kg(-1) d(-1) or TDS gentamicin 6 mg kg(-1) d(-1) divided 8 hourly. Microbiological efficacy, nephrotoxicity, ototoxicity and renal scarring were assessed at the end of treatment.
Results:
210 patients with presumed UTI were recruited, of whom 172 were analysable (OD 84, TDS 88). The median age was 7 mo, 50% were male and 74% (n = 127) of patients had pyelonephritis. The majority of infections were due to Escherichia coli (n = 153, 89%), of which 9 (5.2%) were bacteraemic. Comparing the two groups, there was no significant difference in age, gender, duration of fever before admission, pyuria, nitrite positivity or initial total white blood cell count. All patients had negative urine cultures after 2-3 d of treatment, demonstrating 100% microbiological efficacy. There was no difference between the two groups in terms of ototoxicity, nephrotoxicity, duration of gentamicin treatment or time to fever defervescence.
Conclusion:
OD gentamicin is as efficacious as TDS gentamicin in the treatment of UTI in children, with no difference in ototoxicity and nephrotoxicity.
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