A Multicenter Evaluation of Gentamicin Therapy in the Neonatal Intensive Care Unit

Study Objective . To evaluate traditional nomogram (TN) versus individualized pharmacokinetic gentamicin dosing practices in neonatal intensive care units, focusing on achieving target therapeutic concentrations (peak > 8 μg/ml, trough < 2 μg/ml), number of dosing changes, number of concentrations obtained, and evidence of nephrotoxicity. Design . Retrospective chart review. Setting . Three neonatal intensive care units. Patients . Three hundred nine infants prescribed gentamicin. Intervention . None. Measurements and Main Results . Sixty‐seven percent of patients receiving pharmacokinetic dosing had initial peak concentrations of 8 μ/ml or greater compared with 7% of patients receiving TN dosing (p<0.001). Trough concentrations exceeding 2 μ/ml were reported in 23% of patients receiving TN dosing compared with 2% of pharmacokinetic‐dosed patients (p<0.001). Forty‐two percent and 6%, respectively, required dosage adjustments (p<0.01). The mean number of concentrations obtained per patient was 2.8 and 2.1, respectively (p<0.01). Neither group had evidence of gentamicin‐related nephrotoxicity. Conclusion . Compared with TN dosing, administering gentamicin loading doses and performing initial pharmacokinetic analysis resulted in rapid attainment of desired concentrations and fewer dosage adjustments, and allowed for a decrease in the number of gentamicin concentrations.