Two-compartment gentamicin pharmacokinetics in premature neonates: a comparison to adults with decreased glomerular filtration rates.

Eleven premature neonates received gentamicin sulfate for treatment of suspected gram-negative sepsis with accompanying respiratory distress syndrome. Serum gentamicin concentrations were measured during and after treatment to monitor therapy and to determine the two-compartment distribution and elimination characteristics of the drug. The measured pharmacolinetic parameters were compared to those of 14 adult patients with similar glomerular filtration rates. Neonates, like adults and children, had a prolonged persistence of gentamicin in the serum after treatment was stopped. Although there were marked differences between neonates and adults in administered dose, clearance, and distribution volume when the data were expressed on the basis of body weight, these differences were no longer apparent when the data were expressed relative to body surface area. Differences in gentamicin disposition cannot explain the apparent lack of aminoglycoside nephrotoxicity among premature neonates.