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Two nomograms for determining extended-dosing intervals for gentamicin in neonates
John E Murphy1, Anthony M Roether
1College of Pharmacy, University of Arizona, Tucson, AZ 85721-0202, USA. murphy@pharmacy.arizona.edu <murphy@pharmacy.arizona.edu>
Summary
Two nomograms were developed to predict gentamicin dosing intervals in neonates. These tools showed high accuracy in predicting correct extended-dosing intervals, potentially aiding clinical practice.
Area of Science:
- Pharmacology
- Neonatal Medicine
- Clinical Pharmacy
Background:
- Gentamicin is a crucial antibiotic for treating neonatal infections.
- Optimizing gentamicin dosing is essential to maximize efficacy and minimize toxicity in neonates.
- Accurate prediction of dosing intervals is challenging due to pharmacokinetic variability in this population.
Purpose of the Study:
- To develop and evaluate two nomograms for predicting gentamicin dosing intervals in neonates.
- To achieve target steady-state trough concentrations of less than or equal to 0.5 mg/L or 1 mg/L.
- To utilize a single gentamicin concentration measurement for interval prediction.
Main Methods:
- Pooled data from three retrospective studies involving neonates aged seven days or younger.
- Development of nomograms based on population volume of distribution and determined half-life.
- Simulation of concentration-versus-time profiles using a 4 mg/kg gentamicin dose and individual pharmacokinetic data.
Main Results:
- The 0.5-mg/L and 1-mg/L nomograms predicted correct dosing intervals for 81-92% and 86-93% of neonates, respectively.
- Nomogram accuracy improved with increased postinfusion time before the next concentration measurement.
- Evaluated performance across postinfusion hours from 13 to 21.
Conclusions:
- The developed nomograms show promise in predicting extended gentamicin dosing intervals for neonates.
- These tools may assist in optimizing gentamicin therapy in the neonatal population.
- Prospective validation is recommended for broader clinical application.
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