Performance of a dosage individualization table for extended interval gentamicin in neonates beyond the first week of
Deonne Dersch-Mills1, Albert Akierman2,3, Belal Alshaikh2,3
1a Pharmacy Services, Alberta Health Services, Calgary , Alberta , Canada .
Insights
A gentamicin dosing table effectively individualizes extended-interval dosing (EID) in neonates over 7 days old. This method ensures appropriate peak and trough drug concentrations for safe and effective treatment.
Area of Science:
- Neonatal pharmacology
- Antibiotic dosing optimization
- Pharmacokinetics
Background:
- Gentamicin is a critical antibiotic for neonatal infections.
- Extended-interval dosing (EID) aims to maximize efficacy and minimize toxicity.
- Individualizing gentamicin EID is essential for optimal therapeutic outcomes in neonates.
Purpose of the Study:
- To evaluate the performance of a gentamicin dosing table for individualizing EID in neonates older than 7 days.
- To determine if the table achieves target peak and trough gentamicin concentrations.
Main Methods:
- A prospective observational study involving 38 neonates older than 7 days.
- Neonates received intravenous gentamicin at 5 mg/kg.
- A dosing table, using 22-hour post-dose concentrations, individualized subsequent dosing intervals.
Main Results:
- The dosing table successfully achieved appropriate peak (mean 9.8 ± 1.8 mg/L) and trough (mean 0.6 ± 0.3 mg/L) concentrations in all neonates.
- All trough concentrations were below 2 mg/L, with 83% below 1 mg/L.
- 87% of peak concentrations were within the 5-12 mg/L target range, with 13% in a higher, safe range (12.1-15.7 mg/L).
Conclusions:
- The gentamicin dosing table effectively individualizes extended-interval gentamicin dosages in neonates >7 days old.
- This approach ensures appropriate peak and trough concentrations, supporting early and effective aminoglycoside therapy.
Objective:
To assess the performance of a gentamicin dosing table for the individualization of extended-interval dosing (EID) in a neonatal population >7 days old.
Methods:
A prospective observational study was carried out on gentamicin concentrations achieved using a dosing table in neonates >7 days old. Neonates were given 5 mg/kg IV gentamicin; then a table using 22 h post-first dose gentamicin concentrations was used to individualize dosing intervals. Pre- and post-serum gentamicin concentrations were measured and used to calculate the true peak and trough concentrations achieved.
Results:
Use of the table resulted in dosing intervals that provided appropriate peak (mean 9.8 ± 1.8 mg/L) and trough (mean 0.6 ± 0.3 mg/L) concentrations in all neonates (n = 38). All trough concentrations were <2 mg/L, 83% were <1 mg/L. The majority of peak concentrations were in the usual target range (87%, 5-12 mg/L), with a few being in a higher, although likely safe range (13%, 12.1-15.7 mg/L).
Conclusions:
Use of this dosing table to individualize extended-interval gentamicin dosages in neonates >7 days old resulted in appropriate peak and trough concentrations in all neonates studied. This allows appropriate extended-interval aminoglycoside dosages in neonates early in treatment.
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