PEDIATRICS Vol. 103 No. 3 March 1999, pp. 594-598
Once- Versus Twice-daily Gentamicin Dosing in Neonates 
34
Weeks' Gestation: Cost-effectiveness Analyses
Received Jun 11, 1998; accepted Sep 3, 1998.
,
From the Departments of * Pharmacy and Pediatrics, Section of
Neonatology, University of Colorado Health Sciences Center and
Children's Hospital, Denver, Colorado; and § Magella Medical
Associates, PA, Dallas, Texas.
Objectives. To compare performance
and cost analysis of two gentamicin regimens in infants 
34 weeks'
gestation requiring antibiotics for a 72-hour rule-out sepsis
evaluation. A once-daily dosing (ODD) regimen of 4 mg/kg was compared
with a standard twice-daily dosing (TDD) regimen of 2.5 mg/kg every 12 hours.
Setting and Design. Infants at two university-affiliated
Level III nurseries were prospectively temporally allocated to receive
ODD (n = 27) or TDD (n = 28) as
part of their 72-hour empirical antibiotic regimen. Performance of
dosing regimens was based on target serum gentamicin concentrations
(SGC) established prospectively as a peak of 5 to 10 µg/mL and
a trough of 
2 µg/mL. SGC were determined by fluorescence polarization immunoassay on day 3 of therapy. Cost data were obtained by distributing a questionnaire to 15 pediatric pharmacy practice sites. Inquiries were made regarding hospital cost of drug acquisition, drug supplies, drug preparation and administration, and serum concentration analysis. Performance and cost data were then used to do
a cost-effectiveness analysis.
Results. Mean peak concentrations were higher with ODD (7.9 ± 0.2 µg/mL) than TDD (6.7 ± 0.3 µg/mL). Half of the patients in the TDD group had trough concentrations >2 µg/mL, compared with none in the ODD group. Overall, 57% of the SGCs in the TDD group were outside the target concentration range versus 7% in the ODD group. Based on questionnaire results, a total 72-hour process cost of ODD versus TDD was compared for regimens with and without use of SGC analysis. If SGCs are obtained, more than 75% of the cost associated with gentamicin therapy is attributable to SGC analysis. Based on a cost-effectiveness analysis, ODD was the dominant dosing strategy in all categories analyzed.
Conclusions. ODD of gentamicin at 4 mg/kg in neonates 34
weeks' gestation is the preferable treatment strategy based on: 1)
significantly improved SGC performance compared with TDD; 2)
elimination of the need for routine SGC collection in infants on short
courses of therapy; and 3) significant antibiotic-associated hospital cost savings when compared with conventional therapy of TDD and SGC
analysis.
Key words:
gentamicin,
dosing,
once daily,
drug
concentrations,
peak,
trough,
cost-effectiveness,
pharmacoeconomics,
neonate.
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