Therapeutic drug monitoring for babies receiving gentamicin

1.35 Trough concentrations

1.35.1

If giving a second dose of gentamicin, measure the trough blood gentamicin concentration immediately before giving the second dose. Take the trough concentrations into account before giving the third dose of gentamicin. [2012]

1.35.2

Repeat the measurement of trough concentrations immediately before every subsequent third dose of gentamicin, or more frequently if necessary (for example, if there has been concern about previous trough concentrations or renal function). [2012]

1.35.3

Hospital services should make blood gentamicin concentrations available to healthcare professionals in time to inform the next dosage decision. [2012]

1.35.4

Adjust the gentamicin dose interval, aiming to achieve trough concentrations of less than 2 mg/litre. If the course of gentamicin lasts for more than 3 doses, aim for a trough concentration of less than 1 mg/litre. [2012]

1.35.5

Do not withhold a dose of gentamicin because of delays in getting a trough concentration measurement, unless there is evidence of impaired renal function (for example, an elevated serum urea or creatinine concentration, or anuria). [2012]

1.36 Peak concentrations

1.36.1

Consider measuring peak blood gentamicin concentrations in selected babies, such as in those with:

oedema
macrosomia (birthweight more than 4.5 kg)
an unsatisfactory response to treatment
proven Gram-negative infection. [2012]

1.36.2

When measuring peak blood gentamicin concentrations, take the measurement 1 hour after starting gentamicin. [2012]

1.36.3

If a baby has a Gram-negative or staphylococcal infection, consider increasing the dose of gentamicin if the peak concentration is less than 8 mg/litre. [2012]