Aminoglycoside antibiotics are frequently used for the treatment of sepsis in the newborn infants. Of these aminoglycosides, gentamicin has been prescribed as an antibiotic of the first choice because of its efficacy against many strains of
Gram-negative microorganisms. But inappropriate use of gentamicin can lead to unwanted nephrotoxicity and ototoxicity at certain toxic serum levels. So the author measured peak and trough serum levels of gentamicin in 100 neonates with suspected
and
confirmed sepsis to evaluate the therapeutic serum levels and the incidence of toxic concentrations, subsequently to minimize the appearance of toxicity, and to determine predictors of toxicity such as gestational age and birth weight.
@ES The results were as follows:
@EN 1. The peak serum levels of gentamicin in the first group of premature infants (<34 weeks gestational age) were significantly higher than those in the third group of full term infants (p<0.01). But in 90% of the whole study groups, the peak
concentrations were in the proper therapeutic range (4-10 ㎍/ml). Of the remaining 10%, 8% were in the subtherapeutic range (<4 ㎍/ml) and only 2% were in the toxic levels (>10 ㎍/ml). After all, irrespective of gestational age most of the study
population showed therapeutic peak levels.
2. The trough values of gentamicin according to gestational age were in the toxic range (>2㎍/ml) in 77.3% of the first group, in 29.2% of the second group, in 10% of third group, and in 25% of fourth group. The trough serum levels of the fourth
group
on the interval were significantly lower(p<0.01) than those of the first group on the 12-hour interval, which showed it is reasonable to extend the interval of injection in premature neonates less than 34 weeks of gestational age.
3. The peak serum levels of the first group under 1.5kg of body weight were significantly higher than those of the fourth and fifth groups(p<0.01). But all infants weighing under 2.5kg showed serum peak levels below toxic range and only 2 infants
in the
fourth group weighing more than 2.5kg showed toxic levels.
4. The trough serum levels according to body weight were in the toxic range (>2 g/ml) in 71.4% of the first group, 76.3% of the second group, 25.2% of the third group, 27.0% of the fourth group 25.0% of the fifth group, and 21.5% of the sixth
group.
Especially the first and second groups of low birth weight less than 2.0kg (on the 12-hour interval) showed significantly higher incidence of toxic levels than the comparative body weight groups(the fifth and sixth groups) on the 18-hour
interval(<0.01).
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