Targeting Lower Serum Trough Concentrations: A New Gentamicin Dosing Strategy for Suspected Neonatal Early-Onset...

Area of Science:

• Neonatal pharmacokinetics and pharmacodynamics
• Antibiotic stewardship in neonates
• Therapeutic drug monitoring in pediatrics

Background:

• Neonatal gentamicin dosing algorithms often fail to achieve target trough concentrations (≤1 mcg/mL).
• Elevated gentamicin troughs are associated with increased risk of nephrotoxicity and ototoxicity in neonates.
• Optimizing gentamicin dosing is crucial for effective treatment and minimizing adverse effects.

Purpose of the Study:

• To evaluate a novel gentamicin dosing algorithm incorporating serum creatinine (SCr) and gestational age (GA).
• To determine if the new algorithm can achieve target serum gentamicin trough concentrations ≤1 mcg/mL.
• To assess the impact of the algorithm on the incidence of elevated gentamicin troughs in neonatal populations.

Main Methods:

• Retrospective cohort study in a level IIIB neonatal intensive care unit.
• Comparison of gentamicin trough concentrations before and after algorithm implementation.
• Subgroup analysis based on gestational age (GA): ≤30 weeks, 30-34 weeks, and ≥35 weeks.
• Analysis of serum creatinine (SCr) levels to categorize mild elevation (0.81-0.99 mg/dL) and elevation (≥1 mg/dL).

Main Results:

• The new gentamicin dosing algorithm was implemented and evaluated in 366 neonates.
• Significantly lower percentages of elevated serum gentamicin troughs were observed in neonates with GA of 30-34 weeks (16% lower) and ≥35 weeks (15% lower).
• A statistically significant reduction in elevated serum troughs was noted across all GA groups with elevated SCr (p < 0.001).

Conclusions:

• The gentamicin dosing algorithm based on SCr and GA effectively reduced elevated trough concentrations in neonates.
• The algorithm demonstrated particular efficacy in neonates with a gestational age greater than 30 weeks.
• This approach represents a significant advancement in optimizing gentamicin therapy for neonatal populations.