ABSTRACT
The objective of this study is to determine the safety and efficacy of an extended
interval aminoglycoside dosing guideline implemented in our neonatal intensive care
unit (NICU). A retrospective review of pharmacokinetic data on 44 patients led to
the development of an extended interval aminoglycoside guideline utilizing a 5-mg/kg
dose given at an interval based on postconceptional age and risk factors that may
alter aminoglycoside clearance. After implementation of the new clinical guideline,
a retrospective review of patient records was performed. Thirty-six of 43 peak levels
were within the goal range. Trough levels were < 1 μg/mL in 41 of 46 patients, with
no trough > 2 μg/mL. Thirty-three patients had clinical or culture proven sepsis and
were successfully treated with the new regimen. No difference between pre- and posttreatment
blood urea nitrogen (BUN) and serum creatinine values was observed. Hearing evaluations
were performed in 32 patients with one failure. The patient who failed the hearing
screen, passed a follow-up hearing test. Three deaths, none attributed to infection
or the drug, occurred during the evaluation period. The dosing guidelines developed
for our NICU patients are safe and effective, although evaluation of the long-term
potential for ototoxicity should be performed.
KEYWORD
Neonates - aminoglycosides - dosing guidelines
