Aminoglycoside toxicity in neonates: something to worry about?

Abstract

Toxicity has limited the use of aminoglycosides and adult studies report high rates of both ototoxicity and nephrotoxicity. Conversely paediatric studies have shown lower rates and extended interval dosing may have reduced toxicity further. We review the animal and human evidence for aminoglycoside toxicity in neonates including mechanisms, measurement and rates of toxicity; and differences between aminoglycosides and dosing regimens. We discuss genetic susceptibility and the impact of other synergistic effects.

Keywords::

• amikacin
• aminoglycoside
• gentamicin
• multiple daily doses
• neonatal
• nephrotoxicity
• once-daily dosing
• ototoxicity
• pediatric

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Aminoglycosides appear to have low rates of ototoxicity and nephrotoxicity in neonates.

• No studies are available that report vestibulotoxicity in neonates.

• Ototoxicity is more likely when aminoglycosides are given concomitantly with loop diuretics.

• Ototoxicity is more likely with prolonged courses of aminoglycosides.

• Genetic predisposition accounts for a small proportion of aminoglycoside-induced deafness; practical methods to identity such neonates before administering aminoglycosides are not yet available.