Table 9.3Evidence profile for tobramycin compared with gentamicin in babies with suspected early-onset neonatal infectiona

Number of studiesNumber of babiesEffectQuality
TobramycinGentamicinRelative (95% confidence interval)Absolute (95% confidence interval)
Kidney damageb (nephrotoxicity)
(Itsarayoungyuen 1982)
RR 0.89
(0.22 to 3.55)*
17 fewer per 1000
(117 fewer to 383 more)*
Hearing damagec (ototoxicity)
(Itsarayoungyuen 1982)

FENa fractional excretion of sodium, NAG N-acetyl glucosamine, NC not calculable, RR relative risk, U:S urine to serum


Calculated by the NCC-WCH technical team from data reported in the article


Early-onset infection defined as infection in the first 72 hours of life


Babies who had an increase in serum creatinine of ≥0.4 mg% and developed renal abnormalities (such as haematuria, proteinuria, granular casts, decrease in U:S creatinine ratio, increase in NAG enzyme and increase in FENa) were considered to have developed nephrotoxicity. Assessments were made every 3 days during treatment and when treatment was stopped. 4/20 (20%) babies who received gentamicin and 8/30 (27%) babies who received tobramycin also received concurrent treatment with potentially nephrotoxic medications (for example methicillin, furosemide or indomethacin). No baby was suspected to have any renal abnormalities at the time of inclusion to the study. All seven babies who developed nephrotoxicity were judged to be premature and as having hyaline membrane disease


Auditory function was measured by behavioural screening and/or auditory brainstem response. Timings and frequency of assessment was not described by authors

See the complete GRADE Table J 9.3

From: 9, Antibiotics for suspected infection

Cover of Antibiotics for Early-Onset Neonatal Infection
Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection.
NICE Clinical Guidelines, No. 149.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Aug.
Copyright © 2012, National Collaborating Centre for Women’s and Children’s Health.

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