Abstract
Gentamicin (G) is an aminoglycoside frequently used in the treatment of neonatal sepsis and meningitis. This study reports for the first time the sequential pharmacokinetics of a constant rate one hour intravenous G infusion in 60 small preterm infants during the first week of use. Using a microbiologic technique, the serum G concentration (level) was measured before the 2.5 mg/kg G infusion and 1, 2, 4, 8, and 12 hours after the infusion was started. Mean birthweight and gestational age were 1365 grams (700-2000) and 30.5 weeks (24-36).
Potentially toxic trough and peak levels were observed in some cases along with a markedly prolonged half life (t½). The peak, 2 hour (hr), and 12 hr (trough) levels were 8.25 (1.7-13.0), 5.76 (.25-13.0), and 2.03 (.25-10.8) μg/ml respectively. Drug accumulation was documented. Increasing peak levels were associated with increased trough levels and decreased volume of distribution (VD). Trough levels increased as dose and day of treatment increased and as VD decreased. Drug disposition was very rapid during the first 4 hrs and slower during the last 8 hrs suggesting a two compartment process. T½ was 12.36 hrs and VD .802 </kg (6.82 hrs and 0.629 </kg respectively using a one compartment model). Biweekly monitoring of trough and peak levels is necessary to avoid peak levels >12 μg/ml and trough levels >2 μg/ml while maintaining therapeutic levels of 4-5 μg/ml.
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Coyer, W., Wesbey, G., Cech, K. et al. 240 INTRAVENOUS GENTAMICIN PHARMACOKINETICS IN THE SMALL PRETERM INFANT. Pediatr Res 12 (Suppl 4), 403 (1978). https://doi.org/10.1203/00006450-197804001-00245
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DOI: https://doi.org/10.1203/00006450-197804001-00245