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Medicines for children and gentamicin toxicity
  1. LOUISE GRANT, Clinical Research Fellow
  1. Department of Paediatrics
  2. Southern General Hospital
  3. 1345 Govan Road
  4. Glasgow, UK
  5. louise{at}tadams.demon.co.uk
  6. Department of Paediatrics
  7. Southern General Hospital
    1. PETER MACDONALD, Consultant Paediatrician
    1. Department of Paediatrics
    2. Southern General Hospital
    3. 1345 Govan Road
    4. Glasgow, UK
    5. louise{at}tadams.demon.co.uk
    6. Department of Paediatrics
    7. Southern General Hospital

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      Editor,—Recently, we changed our gentamicin dosing regimen (2.5 mg/kg 18 hourly for preterms and 2.5 mg/kg 12 hourly for term infants) as it resulted in too many low peak blood levels. Levels were taken immediately before and 1 hour after the third dose. We changed to the regimen given in Medicines for Children (MFC)1 shown in table 1 .

      Table 1

      Medicines for Children gentamicin dosing regimen

      However, after making this change we noticed a high number of toxic trough and peak levels. We audited this retrospectively by reviewing the blood gentamicin levels taken during the last two months of the previous regimen and the first two months of the Medicines for Children regimen. All the infants were less than 7 days old. The target levels were trough <2 mg/l, peak 5–10 mg/l. We grouped the three preterm groups given in MFC together to make comparisons easier. The results are given in table 2 .

      Table 2

      Comparison of gentamicin blood levels from previous regimen with those from Medicines for Children regimen

      As intended, the Medicines for Children regimen produced fewer low peaks than the previous regimen in both term and preterm infants (p⩽0.001). However this was at the expense of an excess of high troughs in both term (p=0.014) and preterm (p=0.004) infants and high peaks in the preterm infants (p=0.03). All probabilities were calculated using Fisher's exact test.

      Eleven high peaks or troughs have been excluded from the final figures because of the presence of renal impairment or dosage errors (3 from the previous regimen, 8 from the MFC regimen). Even with the best dosing regimen, there will always be a number of toxic levels due to impaired excretion or dosage error. In view of this, we have changed our antibiotic policy entirely and now use cefotaxime routinely in place of gentamicin. We have a low incidence of cefotaxime resistance in our unit and appreciate that this may not be an option for everyone. Occasionally we will need to use gentamicin for resistant cases and are interested in hearing from anyone who has a gentamicin regimen with which they are happy.

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