Dosage of once-daily gentamicin in spinal cord injury patients

Introduction: In patients with spinal cord injury (SCI), serum creatinine d oes not accurately reflect the level of renal function. Therefore, in SCI p atients, the dose of potentially nephrotoxic drugs should be adjusted on an individual basis from the estimated creatinine clearance. Case report: A 41-year-old male with tetraplegia due to cervical spinal cor d injury underwent extended pyelolithotomy for staghorn calculus in the rig ht kidney. The blood urea level was 9.9 mmol/l; creatinine was 112 umol/l ( reference range: 0-135). We were conscious of this patient's renal disease, and therefore, administered only 3 mg/kg of gentamicin (240 mg) instead of the standard dose of 5 mg/kg body weight. Despite taking this precaution, the gentamicin level measured 22.5 h after the initial dose, was in the pot entially toxic range-3.3 mg/l. Conclusion: We recommend that even the first dose of gentamicin in the once -daily regimen, which is 5 mg/kg, should be individualised in SCI patients based on age, sex, weight, height, level of spinal cord injury, and renal f unction.