What is the available literature for extended interval gentamicin in the pediatric population? Does the data support from a safety and efficacy standpoint? Which nomogram has the most data to support the use of the nomogram?

Comment by InpharmD Researcher

Based on the available evidence, extended-interval, once-daily dosing of gentamicin is the favored approach in pediatric patients to enhance efficacy and minimize toxicity. Current standard dosing regimens, however, frequently fail to achieve target peak and trough concentrations in a significant proportion of neonates and children, highlighting substantial pharmacokinetic variability. Consequently, therapeutic drug monitoring (TDM) is essential to guide dose adjustments and ensure optimal outcomes. Unfortunately, data regarding nomograms are limited. The significant variation in existing clinical practices further underscores the urgency for developing and adopting standardized, uniform guidelines.

Background

The 2023 publication undertakes a retrospective, single-center cohort study at the Beatrix Children’s Hospital to evaluate the effectiveness of current dosing guidelines for gentamicin in neonates and children. The study encompasses data collected between January 2019 and July 2022, involving 658 patients, consisting of 335 neonates and 323 children. The investigators measured the first gentamicin concentration used for therapeutic drug monitoring in each patient, with the target trough concentrations set at ≤1 mg/L for neonates and ≤0.5 mg/L for children, while peak concentrations were set at 8–12 mg/L for neonates and 15–20 mg/L for children. Results indicated that trough concentrations were outside the target range in 46.2% of neonates and 9.9% of children, while peak concentrations were exceeded in 46.0% of neonates and 68.7% of children. Notably, higher creatinine concentrations in children were correlated with increased gentamicin trough concentrations. The findings substantiate earlier observational studies, illustrating that approximately half of the cases did not achieve the target concentrations with standard dosing. The once-daily administration of gentamicin is favored over multiple daily doses to enhance effectiveness while minimizing toxicity. In neonates, the literature recommends initial dosing ranges of 3 to 7.5 mg/kg, and for children, 4 to 10 mg/kg, typically given as a single daily dose. The subsequent dosing is then adjusted based on therapeutic drug monitoring (TDM) to ensure optimal outcomes and reduce the risk of adverse effects. The study further explicates the necessity for refined dosing strategies, particularly highlighting the significant pharmacokinetic variability associated with developmental factors in neonates and children. The research underscores the importance of considering additional clinical parameters to enhance target attainment in pediatric patients, such as gestational and postnatal age and renal function markers. The retrospective nature of the study, combined with its extensive cohort, provides a robust evaluation of current practices and calls attention to the need for ongoing assessment and adjustment of dosing regimens in pediatric antimicrobial therapy. [1]

A 2008 review comprehensively examined the data surrounding the use of extended-interval dosing of gentamicin for the treatment of neonatal sepsis. This detailed exploration included both randomized and non-randomized studies from developed and developing countries. The review meticulously assessed the pharmacokinetic profiles of gentamicin when administered in higher doses at prolonged intervals beyond 24 hours. The analysis revealed that such dosing not only conferred a favorable pharmacokinetic profile but also enhanced clinical efficacy while reducing toxicity, all at a potentially lower cost. The authors suggested an optimal dosing regimen tailored for resource-limited settings: for neonates over 2,500 g, a dose of 13.5 mg every 24 hours; for those between 2,000-2,499 g, 10 mg every 24 hours; and for neonates under 2,000 g, 10 mg every 48 hours was recommended. Furthermore, the review highlighted the global importance of neonatal infections, emphasizing that serious bacterial infections are a leading cause of morbidity and mortality among newborns, particularly in developing countries where neonatal deaths predominantly occur. The study stressed the need for simplified treatment regimens in high-mortality settings to improve antibiotic administration and thereby reduce neonatal sepsis case-fatality rates. The findings underscored the practicality of extended-interval dosing in both health facilities and potentially for community-based management, aiming to optimize treatment strategies for neonatal sepsis in challenging environments where traditional dosing regimens may be logistically demanding. [2]

A 2016 retrospective review evaluated the efficacy and safety of Extended-Interval Aminoglycoside Dosing (EIAD) in pediatric patients. The investigation included patients aged over 3 months who received EIAD with at least two serum drug concentration measurements between February 2013 and December 2014. The study excluded neonates under 44 weeks corrected gestational age, pregnant women, and patients with specific conditions such as cystic fibrosis and acute burn injuries. The analysis focused on 107 courses of gentamicin therapy across 54 patients, assessing parameters like age, gender, weight, concomitant antimicrobial use, renal function, initial dosing regimen, and serum concentrations. The 2016 analysis revealed that the EIAD approach was safe, with no cases of nephrotoxicity detected. The pharmacokinetic evaluation indicated that the mean elimination rate constant (Ke) for the study population was 0.3 hour−1 with a half-life of 2.6 hours. The volume of distribution (Vd) was found to be 0.5 L/kg, and peak serum concentration (Cmax) averaged 17.1 mcg/mL. Age-based dosing, utilizing 9.5 mg/kg for those aged >3 months to <2 years, 8.5 mg/kg for ages 2 to <8 years, and 7 mg/kg for patients aged ≥8 years, efficiently achieved the targeted Cmax range of 15-20 mcg/mL with a C24h of <1 mcg/mL. Although the results were promising, the authors noted the need for future studies to assess potential ototoxicity with prolonged use of EIAD in pediatric populations. [3]

A 2009 retrospective medical record review with pharmacokinetic analysis was conducted within two neonatal intensive care units in a pediatric tertiary care system. This investigation aimed to ascertain the pharmacokinetic outcomes of a simplified, weight-based, extended-interval gentamicin dosing protocol in a sequential sample of 644 critically ill neonates under seven days old without renal dysfunction. These neonates were administered gentamicin on their first day of life for suspected sepsis between February 2003 and January 2008. The protocol involved intravenous administration of a mean dose of 3.96 mg/kg of gentamicin every 48 hours for those weighing less than 1250 g and every 24 hours for those weighing 1250 g or more. For neonates concurrently receiving indomethacin, gentamicin was given every 48 hours. The results indicated that the protocol was effective in achieving therapeutic peak plasma concentrations of gentamicin, with a mean gentamicin peak concentration of 9.38 mg/L and a mean trough concentration of 1.00 mg/L. Notably, 361 neonates, representing 56.1% of the sample, reached the defined successful peak plasma concentration range of 7-10 mg/L, while 610 neonates, or 94.7%, had successful trough concentrations of less than 2 mg/L. The apparent volume of distribution was determined to be 0.48 L/kg and the mean half-life was 8.31 hours. These findings suggest that the protocol may minimize the potential for gentamicin toxicity while effectively achieving therapeutic concentrations in most neonates. [4]

A 2016 survey of Canadian Hospital Pharmacists explored the prescribing practices for high-dose, extended-interval aminoglycosides, specifically gentamicin and tobramycin, in pediatric inpatients across Canada. The research utilized a prospective survey methodology distributed in March 2015 to pharmacists from Canadian health care organizations providing pediatric inpatient services. The survey, crafted with expertise in survey methodology, institutional pharmacy practice, pediatrics, and aminoglycosides, encompassed 18 questions regarding demographic characteristics, clinical indications, dosing, monitoring parameters, and pharmacists' prescribing authority. Forty-five out of the 94 potential participants completed the survey, yielding a 48% response rate. The survey revealed that 78% of the respondents indicated the use of high-dose, extended-interval regimens for pediatric patients in their institutions, with variations in dosing dependent on conditions such as cystic fibrosis, urinary tract infections, and febrile neutropenia. The survey results highlighted significant diversity in dosing and monitoring regimens. Median doses reported were 10 mg/kg for cystic fibrosis, 7 mg/kg for urinary tract infections, and 8 mg/kg for febrile neutropenia. Furthermore, 89% of the institutions reported monitoring serum levels, and 77% monitored for nephrotoxicity, underscoring the emphasis on safety. Also illuminated was that 16% of the pharmacists had the authority to independently adjust dosing, and 31% could independently order monitoring parameters. The gathered data reflects an evident variation in practices across Canada, highlighting the absence of standardized guidelines for aminoglycoside therapy in pediatrics. [5]

References:

[1] Hollander EM, van Tuinen EL, Schölvinck EH, et al. Evaluation of Dosing Guidelines for Gentamicin in Neonates and Children. Antibiotics (Basel). 2023;12(5):810. Published 2023 Apr 25. doi:10.3390/antibiotics12050810
[2] Darmstadt GL, Miller-Bell M, Batra M, Law P, Law K. Extended-interval dosing of gentamicin for treatment of neonatal sepsis in developed and developing countries. J Health Popul Nutr. 2008;26(2):163-182.
[3] Bhagat PH, Bartlett AH, Nash CB. Evaluation of Extended-Interval Aminoglycoside Dosing (EIAD) in Pediatric Patients. Open Forum Infectious Diseases. 2016;3(suppl_1). doi:https://doi.org/10.1093/ofid/ofw172.1491
[4] Hoff DS, Wilcox RA, Tollefson LM, Lipnik PG, Commers AR, Liu M. Pharmacokinetic outcomes of a simplified, weight-based, extended-interval gentamicin dosing protocol in critically ill neonates. Pharmacotherapy. 2009;29(11):1297-1305. doi:10.1592/phco.29.11.1297
[5] Roy C, Gray C, Ruda L, Bell A, Bolt J. High-Dose, Extended-Interval Gentamicin and Tobramycin for Pediatric Inpatients: A Survey of Canadian Hospital Pharmacists. Can J Hosp Pharm. 2016;69(5):367-375. doi:10.4212/cjhp.v69i5.1591

Literature Review

A search of the published medical literature revealed 4 studies investigating the researchable question:

What is the available literature for extended interval gentamicin in the pediatric population? Does the data support from a safety and efficacy standpoint? Which nomogram has the most data to support the use of the nomogram?

Level of evidence

C - Multiple studies with limitations or conflicting results  Read more→



Please see Tables 1-4 for your response.


 

Validation of a dosage individualization table for extended-interval gentamicin in neonates

Design

Prospective observational study

N= 104

Objective

To prospectively validate the use of a 22-hour gentamicin concentration dosing table for the individualization of extended-interval dosing in the neonatal population by examining the peak and trough concentrations achieved through its use

Study Groups

All neonates (n= 104)

Inclusion Criteria

Neonates in the first week of life, gestational age 23 weeks to full term, in level II and III neonatal intensive care units

Exclusion Criteria

Not specified

Methods

Neonates were given gentamicin 5 mg/kg intravenously; a table using 22-hour post-first-dose gentamicin concentrations was then used to individualize dosing intervals. Pre- and post-serum gentamicin concentrations on the dosing interval indicated were measured with the second or third doses and used to calculate the peak and trough concentrations achieved.

Duration

Not specified

Outcome Measures

Primary: Peak and trough concentrations achieved

Baseline Characteristics

Characteristics

All neonates (n= 104)

Gestational age, weeks

23 to full term
Results

Outcome

All neonates (n= 104)

Peak concentration, mean mg/L

10.55

Trough concentration, mean mg/L

0.75

Trough < 2 mg/L

100%

Trough < 1 mg/L

73%

Peak 5-12 mg/L

82%

Peak 12.1-16 mg/L

18%
Adverse Events

Not specified

Study Author Conclusions

Use of a 22-hour post-first-dose gentamicin concentration dosing table to individualize extended-interval gentamicin dosages in neonates resulted in appropriate peak and trough concentrations in all neonates studied. Use of this table will result in appropriate extended-interval aminoglycoside dosages in neonates early in treatment, using a single serum concentration.

Critique

The study provides a practical approach to individualizing gentamicin dosing in neonates, ensuring appropriate peak and trough concentrations. However, the study lacks detailed information on adverse events and does not specify the duration of follow-up, which may limit the understanding of long-term safety and efficacy.

References:

Dersch-Mills D, Akierman A, Alshaikh B, Yusuf K. Validation of a dosage individualization table for extended-interval gentamicin in neonates. Ann Pharmacother. 2012;46(7-8):935-942. doi:10.1345/aph.1R029

 

Extended-Interval Gentamicin Dosing in Achieving Therapeutic Concentrations in Malaysian Neonates

Design

Cross-sectional observational study with pharmacokinetic analysis

N=113

Objective

To evaluate the usefulness of extended-interval gentamicin dosing practiced in neonatal intensive care unit (NICU) and special care nursery (SCN) of a Malaysian hospital

Study Groups

All patients (n=113)

Inclusion Criteria

All neonates younger than 28 days who received gentamicin treatment in the neonatal intensive care unit or special care nursery of Sultanah Fatimah Specialist Hospital

Exclusion Criteria

Subjects were excluded if gentamicin was discontinued before the second dose was given, if the dose prescribed was outside the predefined dosing guidelines (5% difference from the recommended dose), if blood samples were drawn at inappropriate time, and if only 1 sample was sent

Methods

Gentamicin sulphate was given as a 30-minute intravenous infusion. Dosing was according to a modified Australian-based pediatric guideline: 5 mg/kg every 48 hr for <1200 g, 5 mg/kg every 36 hr for 1200-2500 g, and 5 mg/kg every 24 hr for >2500 g and term neonates. Serum gentamicin concentration monitoring was done at the second dose.

Duration

March 2012 to May 2012

Outcome Measures

Primary: Achievement of therapeutic peak (5-10 mg/L) and trough (<2 mg/L) concentrations

Secondary: Pharmacokinetic parameters (volume of distribution, half-life, elimination rate)

Baseline Characteristics

Characteristics

All patients (n= 113)

Sex - Female

39 (34.5%)

Race

Malay

Chinese

Indian

Other

 

81 (71.7%)

25 (22.1%)

2 (1.8%)

5 (4.4%)

Gestational age, wk (Mean ± SD)

35.97 ± 2.75

Weight, kg (Mean ± SD)

2.83 ± 0.85

Serum creatinine, mg/dL (Mean ± SD)

0.77 ± 0.23
Results

Outcome

All patients (n= 113)

Achieved therapeutic range

93 (82.3%)

Achieved target trough SGC (<2 mg/L)

112 (99.1%)

Mean peak concentration, mg/L (95% CI)

8.52 (8.13-8.90)

Mean trough concentration, mg/L (95% CI)

0.54 (0.48-0.60)

Mean volume of distribution, L/kg (95% CI)

0.65 (0.62-0.68)

Mean half-life, hours (95% CI)

6.96 (6.52-7.40)

Mean elimination rate, hour−1 (95% CI)

0.11 (0.10-0.11)
Adverse Events

Not specifically reported in the study

Study Author Conclusions

The larger percentage of subjects attaining therapeutic range with extended-interval gentamicin dosing suggests that this regimen is appropriate and can be safely used among Malaysian neonates.

Critique

The study demonstrated high accuracy in achieving therapeutic concentrations with extended-interval dosing, which is a strength. However, the study's cross-sectional design and limited sample size, especially in the subgroup of neonates ≤ 28 weeks, may limit the generalizability of the findings. Additionally, the study did not measure the long-term safety outcomes such as ototoxicity, which is a limitation.

 

References:

Low YS, Tan SL, Wan AS. Extended-interval gentamicin dosing in achieving therapeutic concentrations in malaysian neonates. J Pediatr Pharmacol Ther. 2015;20(2):119-127. doi:10.5863/1551-6776-20.2.119

Extended-interval Dosing of Gentamicin in Premature Neonates Born at <32 Weeks’ Gestation and >7 Days of age
Design

Observational study

N= 39

Objective To evaluate an extended-interval dosing (EID) regimen of gentamicin in infants born at <32 weeks’ gestational age and aged >7 days
Study Groups

EID group (n= 39)

traditional-interval dosing (TID) group (n= 39)

Inclusion Criteria Infants born at <32 weeks’ gestational age and aged >7 days who received gentamicin for at least 5 days
Exclusion Criteria Major congenital and renal anomalies, neuromuscular disorders, shock, history of cardiopulmonary arrest, nonavailability of paired peak and trough gentamicin levels
Methods Dosing interval based on serum drug concentration at 22 hours after the first dose of 5 mg/kg. Gentamicin peak (5–12 mg/mL) and trough (<2 mg/mL) levels compared to a historical control group receiving TID of 2.5 mg/kg with intervals of 8, 12, or 24 hours. 
Duration January 2012 to June 2012
Outcome Measures Achievement of therapeutic peak and trough levels 
Baseline Characteristics   EID (n= 39) TID (n= 39)
Maternal age, years 30.1 ± 6.4 28.7 ± 5.4
Gestational, wk 26.6 ± 2.0 26 ± 1.9
Postnatal, d 34 ± 27 33 ± 21
Postmenstrual, wk 31.4 ± 4 30.7 ± 3.0
Male 20 (51%) 23 (59%)
Birthweight, g 902 ± 243 819 ± 259
Small for gestational age 2 (5%) 7 (18%)
Weight at start of gentamicin, g 1338 ± 688

1139 ± 357

Antenatal corticosteroids 36 (92%) 37 (95%)
Indomethacin 13 (33%) 14 (36%)
Results   EID group TID group p-value
Peak level, mg/mL 9.0 4.7 <0.001
Trough level, mg/mL 0.7 1.1 <0.001
Adverse Events No adverse effect on renal function in either group. Sensorineural hearing loss in 1 infant in the EID group and 2 infants in the TID group.
Study Author Conclusions An EID gentamicin regimen achieved therapeutic peak and trough levels and performed significantly better than a TID regimen in reaching target levels. Larger-scale trials are needed to assess clinical efficacy.
Critique The study provides valuable insights into EID regimens for preterm infants, but its observational design and small sample size limit the ability to assess clinical efficacy. The study's retrospective nature and lack of randomization may introduce bias. Further large-scale, multicenter trials are needed to confirm these findings.

 

References:

Sundaram A, Alshaikh B, Dersch-Mills D, Dobry J, Akierman AR, Yusuf K. Extended-interval Dosing of Gentamicin in Premature Neonates Born at <32 Weeks' Gestation and >7 Days of age. Clin Ther. 2017;39(6):1233-1241. doi:10.1016/j.clinthera.2017.05.343

Variation in Gentamicin Dosing and Monitoring in Pediatric Units across New South Wales
Design

Survey study

N= 35 units (response rate of 87%)

Objective To describe the dosage regimen for gentamicin and approach to its therapeutic drug monitoring (TDM) among pediatric units within the state of New South Wales (NSW)
Study Groups Pediatric units (n= 35)
Inclusion Criteria Pediatric units in NSW, excluding neonatal units
Exclusion Criteria Neonatal units
Methods A questionnaire was sent electronically to representatives of 40 pediatric units in NSW, requesting details of each unit’s gentamicin dosing and TDM policy. Data were descriptively analyzed with frequency described as numbers and percentages.
Duration April 2015
Outcome Measures Presence of a guideline for gentamicin dosing and TDM, dosing regimen for patients with normal renal function, methods used for gentamicin TDM 
Baseline Characteristics   All units (n= 35)

Respondents

Pediatric specialists

Pediatric JMOs

Pediatric nurses

Pediatric pharmacist

 

17 (48%)

15 (43%)

2 (6%)

1 (3%)

Results   All units (n= 35)
Units without local guidelines for dosing 21 (54%)
Units without local guidelines for TDM 22 (65%)
Use of single daily dose of 7.5 mg/kg 63%
Use of trough levels for TDM 63%
Use of Hartford Nomogram 23%
Adverse Events Not specifically reported in the study.
Study Author Conclusions A significant variation exists in clinical practice among pediatric units in NSW on gentamicin dosing and TDM guidelines. There is an urgent need for collaboration among nursing, medical, and pharmacy experts to achieve consensus to develop and adopt statewide uniform guidelines on gentamicin dosing and TDM.
Critique The study highlights the lack of standardization in gentamicin dosing and TDM practices, which poses a challenge to clinicians. The survey method provides a broad overview but may be limited by response bias and the exclusion of neonatal units. The study calls for a standardized approach to improve safety and efficacy in gentamicin administration across pediatric units in NSW. 

 

References:

Saddi V, Preddy J, Dalton S, Connors J, Patterson S. Variation in Gentamicin Dosing and Monitoring in Pediatric Units across New South Wales. Pediatr Qual Saf. 2017;2(2):e015. Published 2017 Feb 17. doi:10.1097/pq9.0000000000000015