Management and Determining the Cause

Gentamicin Dose

The dose of gentamicin in a neonate with fever for empiric therapy depends on gestational age, postnatal age, and renal function. The typical dosing regimens are:

Neonatal Gentamicin Dosing (IV or IM)

For Term Neonates (≥37 weeks GA)

First week of life:
- 4–5 mg/kg every 24 hours
After first week of life:
- 4–5 mg/kg every 24 hours (may need adjustment based on renal function)
++++++++++++++++++++
Neonatal Gentamicin Dosing (Empiric Therapy)

For Preterm Neonates (<37 weeks GA)

<29 weeks GA:
- 4–5 mg/kg every 48 hours
29–36 weeks GA:
- 4–5 mg/kg every 36 hours

Additional Considerations

Serum levels monitoring: Due to renal immaturity, therapeutic drug monitoring (TDM) is recommended to prevent toxicity.
Adjust based on renal function: If serum creatinine is elevated or urine output is reduced, dosing may need adjustment.
Used in combination with ampicillin for neonatal sepsis or meningitis.
Duration: Typically 48 hours until culture results guide therapy.

[Would you like recommendations on alternative antibiotics or indications for lumbar puncture?

+++++++++++++++++++++++

Preterm neonates (depending on postnatal age and weight)
- <32 weeks GA or <1,200 g: 4–5 mg/kg IV every 48 hours
- 32–37 weeks GA or >1,200 g: 4–5 mg/kg IV every 24–36 hours

Key Considerations:

Renal function monitoring: Gentamicin is renally excreted, and neonates have immature renal clearance.
Therapeutic Drug Monitoring (TDM):
- Peak levels (if monitoring) should be 6–10 mcg/mL
- Trough levels should be <2 mcg/mL (preferably <1 mcg/mL to avoid toxicity)
Used in combination with ampicillin for broad coverage against Group B Streptococcus, E. coli, and other Gram-negative bacteria.

++++++++++++

Would you like specific adjustments based on weight or renal function concerns?