Abstract
Tobramycin produces less serum creatinine increase than gentamicin in adults, suggesting that tobramycin may be less nephrotoxic and safer than gentamicin. The frequent use of aminoglycosides in the neonate led us to compare these agents to determine if tobramycin offers an advantage in safety for the neonate. This randomized, double-blind comparison included infants ≤ 3d age without known renal disease treated a mean of 7.5d with gentamicin (20) or 8d with tobramycin (30). Infants received 2.5mg/kg/12h aminoglycoside. The groups were comparable for gestational age, underlying diseases, apgar score, and clinical condition. After at least one day of therapy the peak serum level was 5.4μg/ml tobramycin and 5.9μg/ml gentamicin and the trough level was 1.8μg/ml tobramycin and 2.3μg/ml gentamicin. There was no significant difference between, tobramycin and gentamicin in the frequency of proteinuria, glucosuria, hematuria, casts or serum creatinine increase of over .4mg% during therapy. Definite nephrotoxicity occurred in 10% of each group. The tobramycin group showed lower average serum creatinine by .3mg% and higher creatinine clearance by 7ml/min/1.73m2 both during and after therapy. After therapy, urine N-acetyl-β glucosaminidase was .09±.02 IU/mg creatinine for tobramycin and .24±.09 IU/mg creatinine for gentamicin. Although tobramycin use resulted in a small improvement in creatinine clearance and less enzymuria, the clinical significance of these observations appears minimal.
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Itsarayoungyuen, S., Riff, L., Schauf, V. et al. 335 TOBRAMYCIN VERSUS GENTAMICIN FOR THE NEONATE. Pediatr Res 15 (Suppl 4), 496 (1981). https://doi.org/10.1203/00006450-198104001-00346
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DOI: https://doi.org/10.1203/00006450-198104001-00346
