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).