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A Multicenter Evaluation of Gentamicin Therapy in the Neonatal Intensive Care Unit
Author(s) -
Glover Mark L.,
Shaffer Christopher L.,
Rubino Christopher M.,
Cuthrell Corey,
Schoening Shellie,
Cole Erika,
Potter David,
Ransom J. Laurence,
Gal Peter
Publication year - 2001
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.21.1.7.34441
Subject(s) - dosing , gentamicin , nephrotoxicity , medicine , pharmacokinetics , nomogram , trough concentration , therapeutic drug monitoring , intensive care , neonatal intensive care unit , toxicity , pharmacology , antibiotics , intensive care medicine , pediatrics , chemistry , biochemistry
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.