Gentamicin and tobramycin in neonates: comparison of a new extended dosing interval regimen with a traditional multiple daily dosing regimen.
ABSTRACT Because of a lack of data supporting traditional dosing regimens for aminoglycosides, especially in extremely low-birth-weight infants, the authors developed revised dosing guidelines. The new guidelines increased doses to 5 mg/kg (over traditional doses of 2.5 mg/kg) and lengthened the dosing interval. When results of the two regimens were compared in 120 infants, 26.8% of infants in the traditional dosing group had subtherapeutic levels at <5 microg/mL, whereas only 1.3% of infants in the new practice dosing group were subtherapeutic. With the new dosing practice, serum levels in 1.3% of infants also exceeded the upper therapeutic range of 12 microg/mL. In conclusion, by increasing the dose of aminoglycosides and extending the dosing intervals, therapeutic levels-as defined by a C min <2 microg/mL and a C max of 5 to 12 microg/mL--were obtained significantly more often. In essence the regimen involves once daily dosing for infants <1200 g who are >30 days of age and for infants <1200 g who are >7 days of age. Serum concentrations still need to be monitored where clinically indicated.
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ABSTRACT: Introduction Gentamicin is widely used in full-term neonates as empirical therapy for early-onset suspected or proven sepsis. Several dosing schedules for gentamicin have been recommended for this neonatal population. Objective To compare gentamicin serum levels, efficacy and toxicity of two dosing schedules in term and preterm newborns. Material and methods The study included 200 newborns who were started on gentamicin therapy. Group A (N = 100) was prescribed a multiple-daily dosing regimen and Group B (N = 100) on a once-daily dosing regimen. Newborns in Group A received gentamicin at 2.5-3.5 mg/kg/dose q12-18 h depending on postnatal age and serum creatinine levels, and newborns in Group B received 4-5 mg/kg/dose q24-48 h depending on postconceptional and postnatal age. All peak and trough serum drug levels, demographic data, and markers of potential nephrotoxicity and ototoxicity were compared. Results Peak serum gentamicin levels were significantly higher (8.2 ± 0.22 μg/ml vs. 5.9 ± 0.13 μg/ml; p ≤ 0.001) andtrough levels were significantly lower (0.9 ± 0.06 μg/ml vs. 1.7 ± 0.08 μg/ml; p ≤ 0.001) in Group B than in Group A. There was no significant difference between the groups either in the clinical failure rate or in the nephrotoxicity or ototoxicity outcomes. Conclusions Once-daily dosing regimen of gentamicin in preterm and term newborns is safe and effective, with a reduced risk of serum drug concentrations falling outside the therapeutic range.Anales De Pediatria - AN PEDIATR. 01/2008; 68(6):581-588.
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ABSTRACT: Empiric dosing of gentamicin has not been evaluated in critically ill neonates with unrepaired congenital heart disease (CHD). Many factors may alter gentamicin pharmacokinetics in this patient population and there are few data describing gentamicin dosing regimens in this patient population. To determine whether an empiric gentamicin dosing regimen for neonates achieves acceptable serum trough concentrations in neonatal patients with unrepaired CHD receiving alprostadil. Term neonates with unrepaired CHD who received gentamicin for empiric treatment of sepsis were identified over a 3-year period. Patients were included if they received gentamicin 4 mg/kg/dose every 24 hours, were receiving alprostadil for maintenance of a patent ductus arteriosus, and had at least one gentamicin serum trough concentration determined. Patients were evaluated to determine whether they achieved a serum trough concentration of <1 mg/L, and differences in patient characteristics were noted for those who achieved an appropriate trough concentration and those who did not. Twenty-eight patients met study criteria, and 22% of patients had a trough gentamicin concentration of <1 mg/L at a mean (SD) time of 23.6 (0.3) hours after a dose. Few statistically significant differences in patient characteristics were noted for those who achieved an appropriate serum trough concentration and those who did not, and included Apgar scores at 1 minute and later day of life at admission. Current empiric gentamicin dosing regimens may not be appropriate for critically ill neonates with unrepaired CHD. Routine serum concentration monitoring may be warranted in this population.Annals of Pharmacotherapy 08/2012; 46(9):1193-7. · 2.92 Impact Factor
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ABSTRACT: The instrumental neutron activation analysis (INAA) and isotope dilution-inductively coupled plasma mass spectrometry (ID-ICP/MS) methods were applied for the determination of trace elements in the tuna fish CRM (KRISS 108-04-021) developed by the Korea Research Institute of Standards and Science (KRISS). Trace elements determined by INAA without any chemical treatment included Al, As, Ca, Co, Fe, K, Na, Sb, Se and Zn. Other elements such as Cd, Cr, Cu, Hg, Pb, Se and Zn were determined after dissolution of the sample by ID-ICP/MS. A combination of results obtained by the two independent methods for Se and Zn was used for the final certified value.Journal of Food Composition and Analysis - J FOOD COMPOS ANAL. 01/2011; 24(7):1064-1068.