Gentamicin in Neonatal Infection : Once Versus Twice Daily Dosage
URAIWAN CHOTIGEAT,M.D.*,
AM PORN NARONGSANTI, B.Sc. **,
DUANGCHIT PANOMVA NA NA A YUDHY A, M.Sc., Ph.D.***
Affiliation : * Neonatal Unit, Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok 10400,
** Department of Pharmacy, Phichit Hospital, Ministry of Public Health, Phichit 66000,
*** Department of Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkom University, Bangkok, 10330, Thailand.
AbstractFifty-four neonates were included and completed the study. Twenty-seven neonates were
given 2.0-2.5 mg/kg of gentamicin twice daily while 27 neonates were given 4.0-5.0 mg/kg of
gentamicin once daily. The twice daily dose and the once daily dose group had mean steady state
gentamicin peak concentrations of 5.94±1.57 mg/1 and 8.92±1.59 mg/1, respectively (p<0.05) while
their trough concentrations were 1.44±0.49 mg/1 and 0.90±0.35 mg/1, respectively (p<0.05). There
were 3 neonates (11.11%) in the twice daily dose group whose peak and trough level were not
within the desirable therapeutic range, two patients with too high trough level (>2 mg/1) and one
with subtherapeutic peak level (< 4 mgn). Only one patient in the once daily group had undesirable
trough level that was higher than 1.5 mg/1 but less than 2 mg/1. Treatment with a once daily dose
did not present more nephrotoxity than a twice daily dose regimen and had the tendency to have
less effect on renal function. Once daily dosage can achieve the equivalent efficacy compared to
a twice-daily dosage regimen. All neonates in twice daily and once daily dosage groups showed
improvement in clinical outcome.
Therefore, a once daily dose of gentamicin with 4.0-5.0 mg/kg could be an appropriate
regimen in term neonates during the first 7 days of life. This regimen produces peak concentration
that may have greater clinical efficacy and trough concentration with less toxicity than conventional
dosing regimen.
Keywords : Gentamicin, Neonatal Infection, Once-Daily, Twice-Daily
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