Pharmacy generalists trained to comply with a systematic care bundle approach enhanced the quality of antimicrobial management.

The standard gentamicin dosing recommendations for neonates appear to be inappropriate because they fail to consider the influence of neonatal development on gentamicin pharmacokinetics. Recent reports have emphasized that the standard regimens of 2.5 mg/kg q8-12h produce steady-state trough serum concentrations > 2 ",g/ml in up to 91 percent of preterm infants of less than 35 weeks' gestation. A new dosing schedule based on postconceptional age (PCA) was developed to provide a better guideline for initiating and maintaining gentamicin therapy in neonates: PCA greater than 34 weeks, 2.5 mg/kg iv qI2h; peA 28-34 weeks, 2.5 mg/kg iv ql6h; PCA less than 28 weeks, 2.5 mg/kg iv q24h. The new dosing schedule reduced the number of neonates with elevated trough concentrations (> 2 ",g/ml) from 68.4 percent to 33-40 percent. Pharmacokinetic parameters for gentamicin in the various PCA groups were determined. Volume of distribution was constant across age groups (0.5 ± 0.09 L/kg). Elimination rate constants (k el ) , half-lives, and clearance rates (CI) ranged from 0.069 ± 0.02 to 0.14 ± 0.04 h-I , 10.71 ± 2.92 to 6.04 ± 1.24 h, and 0.58 ± 0.25 to 0.93 ± 0.24 ml/kg/min, respectively. Significant relationships were found between k el and CI and patient age and weight; significant correlations were found between actual and estimated (based on PCA and weight) k el and Cl. Variability in k el and CI estimated was considerable in spite of the correlations. The observed variability stresses again the need for pharmacokinetic monitoring of gentamicin therapy in neonates. Drug Intell CUn Pharm 1988;22:618-22. GENTAMICIN IS COMMONLY USED in the treatment of neonatal sepsis and meningitis. Dosing guidelines currently used-to initiate and maintain gentamicin therapy in neonates are 2.5 mg/kg q12h for neonates less than one week of age or 2.5 mg/kg q8h for neonates greater than one week of age. These guidelines are designed to

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