Article Text

GENTAMICIN DOSING IN NEONATOLOGY: A SERIES OF AUDITS EVALUATING CURRENT GUIDELINES
  1. G C Menagh1,
  2. J Hall2
  1. 1Department of Paediatrics, Ulster Hospital, Dundonald, N Ireland, UK
  2. 2Safe and Effective Care Department, Ulster Hospital, Dundonald, N Ireland, UK

Abstract

Background Gentamicin is one of the most commonly used drugs in neonatal wards around the world in the treatment of neonatal sepsis. However, elevated levels of gentamicin over 2 mg/l can lead to nephrotoxicity and ototoxicity. This is detrimental to both a child’s health and development so an audit was designed analysing current dosing protocols to ensure best possible practice.

Methods Three audits have been conducted over a period of 3 years looking at separate dosing protocols as suggested by the northern neonatal network (NNN), medicines for children (MC) and the children’s BNF (cBNF). Trough results were gathered from a set time period during each protocol along with appropriate clinical information regarding the patient and then analysed. Neonates with troughs greater than 2 mg/l were considered toxic, a level <0.5 mg/l being subtherapeutic.

Results Toxicity rates were as follows: NNN 32.5%; MC 8.3%; cBNF 20%. Subtherapeutic rates were as follows: NNN 7.5%; both MC and cBNF had no subtherapeutic doses in the sample group. Correlations were noted in all audits between trough levels and two other variables: birth weight and gestation. The strongest correlation was found between birth weight and trough level (Spearman’s Rho correlation value 3.97, p<0.05; data from 2005 audit).

Conclusions Even 8.3% toxicity rates are far from ideal considering the impact nephrotoxicity can have on development. This audit also highlights the need for pharmaceutical companies to invest further in neonatal and child research to ensure the best possible efficacy of medications at minimal risk to the patient.

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