PROSPECTIVE, RANDOMIZED, CONTROLLED EVALUATION OF A GENTAMICIN LOADING DOSE IN NEONATES

Citation
W. Semchuk et al., PROSPECTIVE, RANDOMIZED, CONTROLLED EVALUATION OF A GENTAMICIN LOADING DOSE IN NEONATES, Biology of the neonate, 67(1), 1995, pp. 13-20
Citations number
29
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Pediatrics
Journal title
ISSN journal
0006-3126
Volume
67
Issue
1
Year of publication
1995
Pages
13 - 20
Database
ISI
SICI code
0006-3126(1995)67:1<13:PRCEOA>2.0.ZU;2-X
Abstract
A prospective, randomized, controlled evaluation comparing a 4-mg/kg l oading dose (LD) of gentamicin to the standard regimen of 2.5 mg/kg ev ery 12, 18 or 24 h was conducted in critically ill neonates. The objec tive of the study was to compare the time required to achieve a therap eutic peak serum concentration (i.e. the number of dosing intervals) a nd to compare the number of serum concentrations outside the therapeut ic range as an indicator of potential toxicity between the treatment g roups. Eighteen of 26 patients, 5 of 13 in the control group and 13 of 13 in the LD group (p = 0.012) achieved an initial peak concentration of greater than or equal to 15 mu g/ml following the first gentamicin infusion. There were no significant differences between the control a nd LD group in the number of potentially toxic serum concentrations. W hen patients were subdivided according to gestational age (GA), patien ts of greater than or equal to 34 weeks had significantly lower initia l peak concentrations. A LD of 4 mg/kg in neonates, particularly those of greater than or equal to 34 weeks GA, produced a therapeutic peak concentration following the initial dose. There is a minimal risk of a ttaining serum concentrations commonly associated with toxicity provid ing the dosage interval is adjusted based on serum creatinine determin ations. Based on this study, infants of > 34 weeks GA generally achiev e therapeutic peak concentrations after the first dose with convention al dosing; however, in younger infants an appropriate LD is required t o reach therapeutic concentrations early in therapy.