A simple high-dose gentamicin regimen showed no side effects among neonates.

INTRODUCTION: Treatment of infections in neonates with gentamicin is a balance between optimising bactericidal effect and minimising adverse effects. Previously, at the Neonatal Intensive Care Unit (NICU) at Kolding Hospital, Denmark, neonates suspected of having infections were treated daily with gentamicin 5 mg/kg for the first three days, thus exposing the smallest neonates to double gentamicin amounts compared with those used in most Danish NICUs. We aimed to evaluate if this regimen increased the trough values and oto- and nephrotoxicity. METHODS: Neonates admitted to the NICU between 2008 and 2012 and treated with gentamicin were included retrospectively in the study. Neonates with trough serum (S)-gentamicin level ≥ 2.0 mg/l before the third dose were reviewed in detail. RESULTS: In total, S-gentamicin level was measured in 253 treated neonates of whom 7% displayed elevated trough values. Neonates < 32 weeks of age had a slightly higher incidence of S-gentamicin level ≥ 2.0 mg/l compared with less premature and mature infants (16%, 13%, and 2%, respectively). No oto- or nephrotoxicity was found despite the high-dose gentamicin regimen. CONCLUSIONS: The incidence of elevated S-gentamicin trough levels was increased among very premature neonates. However, no evidence of oto- or nephrotoxicity was observed. This simple regimen of gentamicin 5 mg/kg for the first three days should be considered for all neonates as it potentially minimises the risk of dosing errors and bacterial breakthrough infection. FUNDING: none. TRIAL REGISTRATION: Danish Data Protection Agency (2008-58-0035).

[Two cases of neonatal meningitis after new gentamicin dosing guidelines]. / To tilfaelde af neonatal meningitis efter indførelse af nyt gentamicinregime

Neonates with suspected or proven sepsis are treated with ampicillin and until recently with 5 mg gentamicin/kg every 24 h. New guidelines recommend the same gentamicin dose, but with longer intervals depending on gestational age. Two neonates receiving gentamicin every 48 h improved initially, but both deteriorated again before the second dose. In both infants ampicillin-resistant but gentamicin-sensitive Escherichia coli was found. In one of the infants a resistant/less sensitive E. coli strain was also found in the cerebrospinal fluid. The rationale for the new dosing guidelines is discussed.