Kaspers G J, Teunissen P C, Holl H
Deventer Ziekenhuis.
Ned Tijdschr Geneeskd. 1998 Mar 14;142(11):583-6.
To determine the serum levels of gentamicin in newborn on one or two daily doses.
Retrospective and subsequently prospective, descriptive.
Department of Pediatrics of the Deventer Hospital, the Netherlands.
Gentamicin trough and peak plasma levels were analysed retrospectively in 30 neonates to whom gentamicin 3-4 mg/kg/day in two doses had been administered in 1995. In a subsequent prospective study in 1996, 52 neonates received gentamicin 4 mg/kg/day in one dose. Optimal levels were defined as a trough of < 2 mg/l and a peak of 6-12 mg/l. Levels were determined using a immunoassay.
Both groups were similar in gestational age, weight and age at the start of treatment. Both trough and peak plasma levels were not known in all patients. Adequate gentamicin trough levels were seen more often in the 'once daily' group than in the 'twice daily' group, in both the premature (12/14 = 86% versus 3/7 = 43%; p = 0.04) and non-premature (36/37 = 97% versus 18/23 = 78%; p = 0.017) neonates. Peak levels were higher in the 'once daily' group than in the 'twice daily' group, in both the prematures (11/13 = 85% versus 1/7 = 14%; p = 0.002) and non-prematures (25/28 = 89% versus 2/22 = 9%; p < 0.000001). Optimal trough and peak levels were found in 9/13 (69%) of the premature and 24/27 (89%) of the non-premature neonates treated according to the 'once daily' schedule, compared with 0 and 1/22 (5%) respectively in the neonates treated according to the 'twice daily' regimen (p = 0.003 and p < 0.0001, respectively).
In view of the reported levels and the literature, an initial dose of gentamicin of 4.0 mg/kg/day once a day is advised for neonates.
测定每日一次或两次剂量时新生儿血清庆大霉素水平。
回顾性研究，随后进行前瞻性描述性研究。
荷兰德文特医院儿科。
回顾性分析1995年接受3 - 4mg/kg/日两次剂量庆大霉素治疗的30例新生儿的庆大霉素谷浓度和峰浓度。在1996年随后进行的前瞻性研究中，52例新生儿接受4mg/kg/日一次剂量的庆大霉素治疗。最佳水平定义为谷浓度<2mg/l，峰浓度为6 - 12mg/l。采用免疫分析法测定血药浓度。
两组在治疗开始时的胎龄、体重和年龄相似。并非所有患者的谷浓度和峰浓度均已知。在早产（12/14 = 86% 对 3/7 = 43%；p = 0.04）和非早产（36/37 = 97% 对 18/23 = 78%；p = 0.017）新生儿中，“每日一次”组的庆大霉素谷浓度达标情况比“每日两次”组更常见。在早产（11/13 = 85% 对 1/7 = 14%；p = 0.002）和非早产（25/28 = 89% 对 2/22 = 9%；p < 0.000001）新生儿中，“每日一次”组的峰浓度高于“每日两次”组。按照“每日一次”方案治疗的早产新生儿中有9/13（69%）、非早产新生儿中有24/27（89%）达到了最佳谷浓度和峰浓度，而按照“每日两次”方案治疗的新生儿中分别为0和1/22（5%）（p分别为0.003和p < 0.0001）。
鉴于所报道的血药浓度水平及相关文献，建议新生儿庆大霉素初始剂量为4.0mg/kg/日，每日一次。
