Once-daily gentamicin versus once-daily netilmicin in patients with serious infections—a randomized clinical trial

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Abstract
Consecutive patients with serious infections were randomized between gentamicin 4 mg/kg once daily iv or netilmicin 5⋅5 mg/kg once daily iv (with dosage reduction in case of renal dysfunction). Exclusion criteria were neutropenia or severe renal failure. Median first serum trough and peak concentrations were 0⋅4/9⋅5 mg/L and 0⋅4/12⋅2 mg/L, for gentamicin and netilmicin respectively. A good clinical response was observed in 50/54 (92⋅6%) evaluable patients treated with gentamicin and in 48/52 (92⋅3%) netilmicin-treated patients. Nephrotoxicity (a rise of serum creatinine ≥45 μmol/L) developed in 5/72 (6⋅9%) gentamicin patients treated ≥ 48 hours and in 10/69 (14/5%) netilmicin patients (difference 7⋅5%, 95% CI −39% to + 16⋅2%). High-tone audiometry was performed when possible; no significant differences were found between the regimens with regard to hearing loss or prodromal signs of ototoxicity. We conclude that with once-daily dosing no benefit of netilmicin over gentamicin regarding nephro- or ototoxicity could be demonstrated.

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