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Gentamicin accumulation in neonates — MRCPCH TAS MCQ

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ModeratePharmacologyGentamicin accumulation in neonatesMRCPCH TAS

A 2-day-old term infant receiving gentamicin has a high trough concentration before the second dose. Urine output has fallen after perinatal asphyxia. What is the most likely explanation?

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Correct answer: E — Reduced renal clearance prolonging half-life

Gentamicin is primarily renally cleared, so impaired neonatal renal function increases trough concentrations and toxicity risk. Hepatic glucuronidation is not the main route of gentamicin elimination. The key pearl is that aminoglycoside dosing intervals are strongly influenced by gestation, renal function and measured levels.

Reference: BNFc; Nelson Textbook of Pediatrics; RCPCH Theory examination syllabi