Locksmith Gregory J, Chin Anita, Vu Tammy, Shattuck Karen E, Hankins Gary D V
Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
Obstet Gynecol. 2005 Mar;105(3):473-9. doi: 10.1097/01.AOG.0000151106.87930.1a.
To compare umbilical cord and maternal serum peak gentamicin concentration, gentamicin elimination, and clinical outcomes between women who received once-daily compared with standard, thrice-daily dosing for clinical chorioamnionitis.
We randomly assigned 38 laboring women, at least 34 weeks gestation, with clinical chorioamnionitis, into 1 of 2 gentamicin dosing groups: 5.1 mg/kg every 24 hours (once-daily; n = 18), or 120 mg followed by 80 mg every 8 hours (standard; n = 20). We measured maternal serum peak and delivery gentamicin concentrations and cord serum levels at delivery. Polynomial curve fitting was used to summarize gentamicin elimination. We also compared maternal and neonatal outcomes.
Demographic characteristics of the 2 groups were similar. Median maternal peak gentamicin levels were higher with once-daily (18.2 microg/mL) compared with standard dosing (7.1 microg/mL) (P < .001). Maternal serum levels decreased below 2 microg/mL by 10 hours in the once-daily group and by 5 hours in the standard dosing group. Extrapolated peak cord serum levels were 6.9 microg/mL in the once-daily and 2.9 microg/mL in the standard dosing arm. Cord levels decreased below 2 microg/mL by 10 hours in the once-daily and by 5 hours in the standard dosing group. We found no differences in maternal or neonatal outcomes.
Peak maternal serum gentamicin levels ranged from 13 to 25 microg/mL after a dose of 5.1 mg/kg. Single-dose gentamicin resulted in fetal serum peak levels that were closer to optimal neonatal values. Gentamicin clearance in the term fetus was similar to published values for the newborn infant. No adverse effects of high-dose therapy were noted.
比较接受每日一次与标准的每日三次给药治疗临床绒毛膜羊膜炎的女性，其脐带血和母血中庆大霉素的峰值浓度、庆大霉素清除率及临床结局。
我们将38名孕周至少34周且患有临床绒毛膜羊膜炎的临产女性随机分为2个庆大霉素给药组之一：每24小时5.1mg/kg（每日一次；n = 18），或先给予120mg，随后每8小时给予80mg（标准给药；n = 20）。我们在分娩时测量母血中庆大霉素的峰值浓度、分娩时的浓度及脐带血中的水平。采用多项式曲线拟合来总结庆大霉素的清除情况。我们还比较了母婴结局。
两组的人口统计学特征相似。每日一次给药组的母血庆大霉素峰值中位数（18.2μg/mL）高于标准给药组（7.1μg/mL）（P <.001）。每日一次给药组母血水平在10小时时降至2μg/mL以下，标准给药组在5小时时降至该水平以下。每日一次给药组脐带血峰值浓度外推值为6.9μg/mL，标准给药组为2.9μg/mL。每日一次给药组脐带血水平在10小时时降至2μg/mL以下，标准给药组在5小时时降至该水平以下。我们发现母婴结局无差异。
给予5.1mg/kg剂量后，母血中庆大霉素峰值水平在13至25μg/mL之间。单剂量庆大霉素导致胎儿血中峰值水平更接近新生儿最佳值。足月胎儿中庆大霉素的清除率与已发表的新生儿值相似未见高剂量治疗的不良反应。
