Journal of Targeted Drug Delivery

Clinical Pharmacology of Gentamicin in Infants and Children

Author(s): Gian Maria Pacifici

Gentamicin is an aminoglycoside antibiotic and it is active against aerobic gram-negative bacilli such as Pseudomonas, Klebsiella, and Escherichia coli. Gentamicin should be co-administered with a β-lactam antibiotic. This antibiotic is rapidly bactericidal as it inhibits bacterial cell protein synthesis. Bacterial killing is concentration dependent: the higher the concentration, the greater the rate of bacterial killing. Dosing recommendations are based on: (1) higher gentamicin peak concentrations, (2) post-antibiotic effect on bacterial killing, especially when treating concurrently with a β-lactam antibiotic, and (3) less toxicity with less frequent gentamicin dosing, due to low renal gentamicin accumulation. When gentamicin trough concentration is > 2 μg/ml, intervals among gentamicin doses should be extended to yield gentamicin trough concentration < 2 μg/ml. In infants, gentamicin dose should be 4 – 5 mg/kg. Once-daily gentamicin dosing is preferred than twice- or thrice-daily gentamicin administration. Once-daily gentamicin dosing yields lower trough and higher peak gentamicin concentrations. The recommended peak and trough gentamicin serum concentrations range from 5 to 12 μg/ml, and from 0.5 to 1 μg/ml, respectively. In very-low-birth weight, gentamicin half-life and distribution volume are 12.9 hours and 0.72 l/kg, respectively. In small-for-gestational age infants, with an age ≤ 7 days of life, gentamicin half-life is longer, and clearance is lower than in infants appropriate-for-gestational age. Gentamicin increases the risk of hearing loos, and causes renal dysfunction. Ototoxicity rate in preterm infant’s runs at 2-15% compared to 0.3% in full-term infants and it is permanent in 2-3% of cases, whereas nephrotoxicity is transient. Some bacteria may become resistant to gentamicin. The aim of this study is to review the published data on effects, pharmacokinetics, and bacterial-resistance of gentamicin in infants and children.

Download pdf

Will be updated soon

Mission and Vision Membership Withdrawal Policy Submit Paper Publication ethics
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License © 2018