Once vs. Twice Daily Gentamicin Therapy in Neonates: a Comparison of Its Induced Nephro- and Ototoxicity

Background: Gentamicin is a commonly used antibiotic in neonatal intensive care units with known renal and auditory toxic effects. Several studies have aimed to reduce these adverse effects, which are mainly related to dosage and infusion rate. Reducing the frequency of gentamicin injections may save time, money, and human resources. This study aimed to compare the toxic effects of gentamicin administered once daily versus twice daily in neonates. Methods: All neonates hospitalized in the NICU who met eligibility criteria and were receiving gentamicin therapy were recruited using a non-random, target-based sampling method. Participants were randomly assigned to two groups: group A received gentamicin once daily, and group B twice daily. Therapeutic efficacy, nephrotoxicity, ototoxicity, and mortality rates were compared between the groups based on clinical evaluation, laboratory data, and audiometric tests. Serum urea and creatinine levels were assessed to evaluate nephrotoxicity, while otoacoustic emissions (OAE) and automated auditory brainstem response (AABR) tests were used to assess ototoxicity.Results: Therapeutic effectiveness and nephrotoxicity were similar between the groups. Audiometric tests were normal in group A, whereas 6 patients in group B showed abnormal OAE and AABR results, which was statistically significant (P=0.012). No neonatal deaths occurred in either group.Conclusion: Once-daily gentamicin administration results in fewer audiological side effects compared to twice-daily dosing, highlighting its importance in reducing toxicity and conserving resources.