OPTIMIZATION OF GENTAMICIN THERAPY IN VERY LOW BIRTH-WEIGHT INFANTS

1 January 1985

journal article
research article

Vol. 5 (1) , 79-87

Abstract

In order to optimize gentamicin (G) [an antibacterial drug] therapy G pharmacokinetics were studied in 48 preterm infants (gest. [gestational] age 31.6 .+-. 3.4, range 25-37 wk; birth wt 1.5 .+-. 0.5 kg, range 0.7-2.5 kg). They received i.v. G twice daily (5.2 .+-. 0.6 mg/kg per day). After at least 2 days of treatment trough and peak levels were measured for 2 successive doses. Trough levels were significantly higher in infants < 1 kg receiving 5 mg/kg per day than in other infants (1-2.5 kg) who received the same dose (3.1 .+-. 1.0 vs. 2.3 .+-. 0.5 .mu.g/ml; P < 0.01). Mean G t1/2 [half-life] was significantly longer in infants under 1 kg than in those weighing 1-2.5 kg (7.9 .+-. 1.9 and 6.5 .+-. 1.6 h, respectively; P < 0.01). These differences could be attributed to lower G clearance in infants < 1 kg (31 .+-. 6 vs. 39 .+-. 8 ml/kg per h; P < 0.005). There was no difference in G distribution volume between < 1 kg and 1-2.5 kg infants (0.35 .+-. 0.07 and 0.38 .+-. 0.13 l/kg, respectively). A correlation was found between clearance and t1/2 for the total group (r = 0.57, P < 0.01). No correlation was detected between BUN [blood urea nitrogen] and clearance or between gestational age and clearance. G dose in infants < 1 kg should apparently be reduced to 3.5-4 mg/kg per day in order to avoid excessive levels associated with nephrotoxicity.

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