Clinical strategies: Neonates and children

Neonates (0-28 days)

Due to the rapid escalation in neonatal renal function, the dosing strategy for aminoglycosides also needs careful consideration.

• When using gentamicin in the first seven days of life, a dose of 5 mg/kg every 36 hours is generally recommended. After this, the dose remains the same, but the interval can be reduced to every 24 hours. If the baby is born before the 30th week of gestation, it is often necessary to extend the dosing interval to 48 hours for the first 7 days of life, then reduce as above for full-term babies.
• Amikacin is generally avoided in neonates. It may be used in extreme circumstances, at a dose of 15 mg/kg, with very close therapeutic drug monitoring (TDM) to determine whether the dosing interval needs to be extended.

Infants (1-12 months)

Aminoglycosides can be given every 24 hours in those aged 1 month or older, and because of their increasing renal function in the first 6 months of life and their larger proportion of body water, larger doses are often recommended.

• Doses of up to 7.5 mg/kg every 24 hours are recommended for gentamicin.
• Amikacin is generally avoided below the age of 1 month, but doses of 15 mg/kg once-daily are used from this age onwards.
• Tobramycin is generally used for cystic fibrosis at a dose of 10 mg/kg (max. 600 mg) every 24 hours.

Children (1-12 years)

As the distribution and amount of body water reduces with age, the recommended daily dose of aminoglycosides may also need to be reduced compared to infants.

• For gentamicin the dosing regimen is usually 5 mg/kg every 24 hours, though some local guidelines recommend higher doses of 7 mg/kg every 24 hours.
• Dosing regimens for tobramycin and amikacin remain the same in children as they do for infants. However, children requiring amikacin to treat cystic fibrosis lung infections may require doses up to 30 mg/kg (max. 1.5 g per dose) once daily with TDM.

In the next step, you will learn more about clinical strategies for using aminoglycosides in elderly patients.