Background and aims Aminoglycosides with penicillin are commonly used first line antimicrobials of choice to target early onset sepsis organisms (1). The concern about emergence of gentamicin resistant gram-negative organism has led neonatal units to switch to Amikacin (2). The current British National formulary (BNFc) recommends a dose of 15 mg/kg/day even for preterm infants. The ideal dose of amikacin for use in preterm infants is not clearly defined. The aim of this study was to compare amikacin blood levels in preterm infants less than 32 weeks gestation receiving two dosage regimens.
Methods During initial six-month period infants received amikacin dose of 12 mg/kg/day (group 1) and subsequently after a change to 12 mg/kg every 36 h (group 2) at the neonatal unit over a four-month period at Royal London Hospital. Data was collected from the neonatal database, hospital records and drug chart. Study was approved by Clinical effectiveness unit and Chi-square tests used for analysis (SPSS v22).
Conclusions Most preterm infants even on a lower dose of amikacin than currently recommended by BNFc develop a high trough level. There was a significant reduction in the number of babies with high trough amikacin levels after the dose was changed from 12 mg/kg/day to 12 mg/kg every 36 hours. We recommend this dose for use in infants less than 32 weeks gestation with continued monitoring of amikacin levels.
Vergnano et al. Neonatal infections in England: the NeoniN surveillance network. ADC 2011
Hasvold et al. Gentamicin resistance among Escherichia coli strains isolated in neonatal sepsis. Journal of Neonatal-Perinatal Medicine 2013