Routine Monitoring of Gentamicin Serum Concentrations in Pediatric Patients with Normal Renal Function is Unnecessary

Abstract

OBJECTIVE:

Due to increasing demands for cost containment within the healthcare system, we evaluated the need for routine gentamicin concentrations (i.e., peak and trough with third dose).

DESIGN:

Single-institution study performed concurrently with hospitalization.

SETTING:

A 225-bed pediatric teaching hospital.

PARTICIPANTS:

The study population consisted of 150 hospitalized pediatric patients (53% medicine, 47% surgical patients) from 3 months to 15 years old with normal serum creatinine.

OUTCOME MEASURES:

If the administered dose produced diagnoses-appropriate peak concentrations of at least 4 μg/mL or 5 μg/mL in bacteremia/septicemia and at least 6 μg/mL or 8 μg/mL in patients with pneumonia if trough serum gentamicin concentrations were less than 2 μg/mL, if the patient was noted by the attending physician to be clinically responding as well as objectively having a decreased white blood cell count and was afebrile, and if there was not an increase of 0.5 mg/dL or more in serum creatinine during the course of therapy.

RESULTS:

Patients received a mean dose of gentamicin 2.51 ± 0.14 mg/kg iv q8h, which resulted in a mean peak concentration of 6.1 ± 1.7 μg/mL (range 2.4–11.7) and a mean trough concentration of 0.5 ± 0.3 μg/mL (range 0.1–1.8). Peak and trough concentrations were at least 4 μg/mL and less than 2 μg/mL in 96% and 100% of patients, respectively. No patient required a dosage change due to lack of clinical response.

CONCLUSIONS:

Our data do not support the routine monitoring of gentamicin concentrations in pediatric patients older than 3 months of age who are receiving appropriate standard doses of gentamicin and have normal renal function.