EC Pharmacology and Toxicology

Perspective Volume 13 Issue 7 - 2025

Balancing Augmented Renal Clearance and Renal Immaturity in Gentamicin Dosing for Premature Neonates: Challenges and Solutions

Khalid A Alfaifi1*, Sultan Alzahrani2, Abdurahman Alzahrani3, Khalid Alnemari4, Faisal K5, Yousef K6, Sama K7, Sajwa A8, Faisal B7, Mohammad A Alfaifi9 and Ahmad S10

1Medical Services Directorate, Pharmacy Department, Collaborative Researcher with King Abdulaziz University, Faculty of Medicine, Department of Medical Pharmacology, Jeddah, Saudi Arabia
 2Consultant in Emergency Medicine, Medical Services Directorate, Taif, Saudi Arabia
 3Department of Pharmacy, Medical Services Directorate, Riyadh, Saudi Arabia
 4Department of Pharmacy, Medical Services Directorate, Taif, Saudi Arabia
 5College of Pharmacy, Taif University, Taif, Saudi Arabia
 6Prince Sultan College of Health Sciences, Dhahran, Saudi Arabia
 7College of Medicine, Taif University, Taif, Saudi Arabia
 8College of Pharmacy, King Khalid University, Abha, Saudi Arabia
 9Nursing College, King Saud University, Riyadh, Saudi Arabia 10Pharmacy Department, Khamis Mushait Maternity and Children Hospital, Khamis Mushait, Saudi Arabia

*Corresponding Author: Khalid A Alfaifi, Medical Services Directorate, Pharmacy Department, Collaborative Researcher with King Abdulaziz University, Faculty of Medicine, Department of Medical Pharmacology, Jeddah, Saudi Arabia.
Received: July 02, 2025; Published: July 14, 2025




Gentamicin, a widely used aminoglycoside for neonatal infections, presents a unique challenge in premature neonates due to the interplay between augmented renal clearance (ARC) and renal immaturity. ARC accelerates drug elimination, risking subtherapeutic levels, whereas immature renal function slows clearance, increasing the potential for toxicity. This review examines the underlying mechanisms, clinical implications, and strategies for optimizing gentamicin dosing through pharmacokinetic/pharmacodynamic (PK/PD) modeling and therapeutic drug monitoring (TDM). The integration of artificial intelligence (AI) and physiologically based pharmacokinetic (PBPK) models offers promising avenues for individualized neonatal therapy.

 Keywords: Augmented Renal Clearance (ARC); Renal Immaturity; Premature Neonates; Gentamicin Dosing; Therapeutic Drug Monitoring (TDM)

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Khalid A Alfaifi., et al. "Balancing Augmented Renal Clearance and Renal Immaturity in Gentamicin Dosing for Premature Neonates: Challenges and Solutions". EC Pharmacology and Toxicology 13.7 (2025): 01-05.

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