Miron D, Steinfeld M, Hasanein J, Felszer C, Reich D
Pediatric Department A, Ha'Emek Medical Center, Afula.
Harefuah. 2003 Jun;142(6):413-5, 487.
Gentamicin is an important factor in the empiric therapy of premature babies with suspected invasive bacterial infection. The aims of the study were to assess the tolerability of short course of gentamicin in preterm neonates.
Preterm neonates aged 24 hours or less who were born at 32-37 weeks of gestation and weighed over 1500 grams were included in the study. Those infants suspected of having invasive non-CNS bacterial infection were assigned to treatment with ampicillin 50 mg/kg twice daily and either ODD (once daily dosing) or twice daily dosing (TDD) of gentamicin 5 mg/kg/day (17 and 18 patients, respectively). Neonates with shock, impaired renal function and known kidney, ear, and heart malformations, and metabolic disease were excluded from the study. At 72 to 96 hours of therapy, serum and urine creatinine, and sodium concentrations, peak (PGt) and though (TGt) serum levels of gentamicin, and urinary lysosyme secretion were measured. Fractional excretion of sodium (FeNa), and glomerullar filtration rate (GFR) were calculated for each infant. Audiometric evaluation was performed at 1 to 2 months of age.
For the ODD and TDD groups respectively, the values of serum creatinine, FENa, GFR, and urinary lyzozim were similar. The mean SD PGt levels were 9.9 +/- 4.6 vs 5.9 +/- 1.9 g/ml (p < 0.04), and that of the TGt levels was 1.55 +/- 0.55 vs 2.4 +/- 0.9 micrograms/ml (p = 0.028), Ten (55.6%) vs 3(23.1%) of the TDD and ODD groups respectively had TGt levels above 2 micrograms/ml (p = 0.035). Audiometric evaluation was normal in all infants.
Short course of ODD of gentamicin could be safe and potentially more effective in preterm babies.
庆大霉素是对疑似侵袭性细菌感染的早产儿进行经验性治疗的重要因素。本研究的目的是评估早产儿短疗程使用庆大霉素的耐受性。
纳入妊娠32 - 37周出生、年龄24小时及以内、体重超过1500克的早产儿。那些疑似患有侵袭性非中枢神经系统细菌感染的婴儿被分配接受每日两次、每次50毫克/千克氨苄西林治疗，以及每日一次（ODD）或每日两次（TDD）、每次5毫克/千克/天庆大霉素治疗（分别为17例和18例患者）。休克、肾功能受损、已知有肾脏、耳朵和心脏畸形以及代谢疾病的新生儿被排除在研究之外。在治疗72至96小时时，测量血清和尿肌酐、钠浓度、庆大霉素血清峰值（PGt）和谷值（TGt）水平以及尿溶菌酶分泌。计算每个婴儿的钠分数排泄（FeNa）和肾小球滤过率（GFR）。在1至2个月大时进行听力评估。
ODD组和TDD组的血清肌酐、FeNa、GFR和尿溶菌酶值相似。PGt平均标准差水平分别为9.9±4.6与5.9±1.9微克/毫升（p < 0.04），TGt水平分别为1.55±0.55与2.4±0.9微克/毫升（p = 0.028），TDD组和ODD组分别有10例（55.6%）和3例（23.1%）的TGt水平高于2微克/毫升（p = 0.035）。所有婴儿的听力评估均正常。
短疗程ODD使用庆大霉素对早产儿可能是安全的，且可能更有效。
