4CPS-239 Therapeutic drug monitoring of gentamicin in neonates

Background and importancePeak (maximum plasma concentration)/MIC >8–15 is a pharmacokinetic (PK)/pharmacodynamic (PD) parameter that best correlates with the effectiveness of aminoglycosides. A peak between 8 and 15 mg/L is necessary to achieve this. In neonates, doses of 3–5 mg/kg/day for the fi...

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Published in:European journal of hospital pharmacy. Science and practice 2021-03, Vol.28 (Suppl 1), p.A34-A35
Main Authors: Ortega-Garcia, MP, Zaragozá- González, M, Pérez-Villalón, P, Gil-Gómez, I, Moya-Gil Ana, A, Gómez-Bayona, E, Laguía-Sánchez, R, Blasco-Segura, P
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container_title European journal of hospital pharmacy. Science and practice
container_volume 28
creator Ortega-Garcia, MP
Zaragozá- González, M
Pérez-Villalón, P
Gil-Gómez, I
Moya-Gil Ana, A
Gómez-Bayona, E
Laguía-Sánchez, R
Blasco-Segura, P
description Background and importancePeak (maximum plasma concentration)/MIC >8–15 is a pharmacokinetic (PK)/pharmacodynamic (PD) parameter that best correlates with the effectiveness of aminoglycosides. A peak between 8 and 15 mg/L is necessary to achieve this. In neonates, doses of 3–5 mg/kg/day for the first week and 7.5 mg/kg/day from the second to the fourth week of life are recommended.Aim and objectivesTo evaluate the degree of adequacy of the initial dose with current recommendations and whether therapeutic drug monitoring (TDM) allows optimisation of treatment.Material and methodsA retrospective study was conducted from 1 January 2016 to 29 February 2020, in a general university hospital. Patients 0–35 days old treated with gentamicin and with plasma concentrations (Cp) were reviewed. The descriptive analysis was performed with the SPSSV.24 programme.Results47 patients with a median age of 3 days (0–33) were studied, 33 male. 26 (55.3%) were
doi_str_mv 10.1136/ejhpharm-2021-eahpconf.71
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A peak between 8 and 15 mg/L is necessary to achieve this. In neonates, doses of 3–5 mg/kg/day for the first week and 7.5 mg/kg/day from the second to the fourth week of life are recommended.Aim and objectivesTo evaluate the degree of adequacy of the initial dose with current recommendations and whether therapeutic drug monitoring (TDM) allows optimisation of treatment.Material and methodsA retrospective study was conducted from 1 January 2016 to 29 February 2020, in a general university hospital. Patients 0–35 days old treated with gentamicin and with plasma concentrations (Cp) were reviewed. The descriptive analysis was performed with the SPSSV.24 programme.Results47 patients with a median age of 3 days (0–33) were studied, 33 male. 26 (55.3%) were &lt;1 week old. 34 (72.3%) were admitted for neonatal sepsis and 7 (14.9%) for urinary infection. Gentamicin was used in combination with ampicillin in 45 cases (95.7%) and empirically in 34 (72.3%). The initially prescribed dose was 4 mg/kg/day in 36 (77%) and 5 mg/kg/day in 8 (17%), with no differences in weeks of life. Cp were extracted with a median of 2 days (1–4) after the start, the median peak was 7.5 mg/L (3.5–21.6) and 29 (62%) had a peak &lt;8 mg/L. The trough was &lt;0.2 mg/L in 26 patients and of those that were quantified, the median was 0.4 mg/L (0.2–1.3), and was higher than 1 mg/L in only one case. It was recommended to increase the dose in 26 (55.3%) and reduce it in 4 (8.5%) patients, with 90% acceptance. A second Cp determination was requested in 16 (34%) cases with a median peak of 9 mg/L (6–12) and trough levels always &lt;0.5 mg/L. It was recommended to increase the dose in 5 cases with an acceptance of 94%.Conclusion and relevanceThe dose prescribed was lower than recommended in neonates &gt;1 week old. Cp allowed detection and correction of deviations from the recommended peak or trough levels in 64% of cases, mainly due to low peak levels, with high acceptance of TDM. Plasma determination and TDM of gentamicin continues to be an essential tool to achieve the recommended PK/PD profile.References and/or acknowledgementsConflict of interestNo conflict of interest</description><identifier>ISSN: 2047-9956</identifier><identifier>EISSN: 2047-9964</identifier><identifier>DOI: 10.1136/ejhpharm-2021-eahpconf.71</identifier><language>eng</language><publisher>London: BMJ Publishing Group LTD</publisher><subject>Conflicts of interest ; Drug dosages</subject><ispartof>European journal of hospital pharmacy. Science and practice, 2021-03, Vol.28 (Suppl 1), p.A34-A35</ispartof><rights>Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Ortega-Garcia, MP</creatorcontrib><creatorcontrib>Zaragozá- González, M</creatorcontrib><creatorcontrib>Pérez-Villalón, P</creatorcontrib><creatorcontrib>Gil-Gómez, I</creatorcontrib><creatorcontrib>Moya-Gil Ana, A</creatorcontrib><creatorcontrib>Gómez-Bayona, E</creatorcontrib><creatorcontrib>Laguía-Sánchez, R</creatorcontrib><creatorcontrib>Blasco-Segura, P</creatorcontrib><title>4CPS-239 Therapeutic drug monitoring of gentamicin in neonates</title><title>European journal of hospital pharmacy. Science and practice</title><description>Background and importancePeak (maximum plasma concentration)/MIC &gt;8–15 is a pharmacokinetic (PK)/pharmacodynamic (PD) parameter that best correlates with the effectiveness of aminoglycosides. A peak between 8 and 15 mg/L is necessary to achieve this. In neonates, doses of 3–5 mg/kg/day for the first week and 7.5 mg/kg/day from the second to the fourth week of life are recommended.Aim and objectivesTo evaluate the degree of adequacy of the initial dose with current recommendations and whether therapeutic drug monitoring (TDM) allows optimisation of treatment.Material and methodsA retrospective study was conducted from 1 January 2016 to 29 February 2020, in a general university hospital. Patients 0–35 days old treated with gentamicin and with plasma concentrations (Cp) were reviewed. The descriptive analysis was performed with the SPSSV.24 programme.Results47 patients with a median age of 3 days (0–33) were studied, 33 male. 26 (55.3%) were &lt;1 week old. 34 (72.3%) were admitted for neonatal sepsis and 7 (14.9%) for urinary infection. Gentamicin was used in combination with ampicillin in 45 cases (95.7%) and empirically in 34 (72.3%). The initially prescribed dose was 4 mg/kg/day in 36 (77%) and 5 mg/kg/day in 8 (17%), with no differences in weeks of life. Cp were extracted with a median of 2 days (1–4) after the start, the median peak was 7.5 mg/L (3.5–21.6) and 29 (62%) had a peak &lt;8 mg/L. The trough was &lt;0.2 mg/L in 26 patients and of those that were quantified, the median was 0.4 mg/L (0.2–1.3), and was higher than 1 mg/L in only one case. It was recommended to increase the dose in 26 (55.3%) and reduce it in 4 (8.5%) patients, with 90% acceptance. A second Cp determination was requested in 16 (34%) cases with a median peak of 9 mg/L (6–12) and trough levels always &lt;0.5 mg/L. It was recommended to increase the dose in 5 cases with an acceptance of 94%.Conclusion and relevanceThe dose prescribed was lower than recommended in neonates &gt;1 week old. Cp allowed detection and correction of deviations from the recommended peak or trough levels in 64% of cases, mainly due to low peak levels, with high acceptance of TDM. Plasma determination and TDM of gentamicin continues to be an essential tool to achieve the recommended PK/PD profile.References and/or acknowledgementsConflict of interestNo conflict of interest</description><subject>Conflicts of interest</subject><subject>Drug dosages</subject><issn>2047-9956</issn><issn>2047-9964</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNo9kM1KAzEcxIMoWGrfYcXz1uSfZLO5KcUvKChYzyFJk26Km6zZ3YM3L76oT2JLrTAwcxhm4IfQJcFzQmh17bZN1-jcloCBlE43nU3RzwU5QRPATJRSVuz0P_PqHM36PhjMKa0lo3KCbtji5bUEKn--vleNy7pz4xBssc7jpmhTDEPKIW6K5IuNi4Nugw2x2Cm6FPXg-gt05vV772Z_PkVv93erxWO5fH54WtwuS0OAkdJiDbpmRoKopaHOAbdrzSRwD4Jb5wELh4nn1kiJNfGyJgYwddRbbYWkU3R12O1y-hhdP6htGnPcXSrgmBAJFdBdix1apt2qLodW509FsNrjUkdcao9LHXEpQegvabhjAw</recordid><startdate>202103</startdate><enddate>202103</enddate><creator>Ortega-Garcia, MP</creator><creator>Zaragozá- González, M</creator><creator>Pérez-Villalón, P</creator><creator>Gil-Gómez, I</creator><creator>Moya-Gil Ana, A</creator><creator>Gómez-Bayona, E</creator><creator>Laguía-Sánchez, R</creator><creator>Blasco-Segura, P</creator><general>BMJ Publishing Group LTD</general><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>202103</creationdate><title>4CPS-239 Therapeutic drug monitoring of gentamicin in neonates</title><author>Ortega-Garcia, MP ; Zaragozá- González, M ; Pérez-Villalón, P ; Gil-Gómez, I ; Moya-Gil Ana, A ; Gómez-Bayona, E ; Laguía-Sánchez, R ; Blasco-Segura, P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b1241-c0a2a84b92789b3ee25cda4925f275cef207e01f5cb990a1f981b203e3fcac793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Conflicts of interest</topic><topic>Drug dosages</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ortega-Garcia, MP</creatorcontrib><creatorcontrib>Zaragozá- González, M</creatorcontrib><creatorcontrib>Pérez-Villalón, P</creatorcontrib><creatorcontrib>Gil-Gómez, I</creatorcontrib><creatorcontrib>Moya-Gil Ana, A</creatorcontrib><creatorcontrib>Gómez-Bayona, E</creatorcontrib><creatorcontrib>Laguía-Sánchez, R</creatorcontrib><creatorcontrib>Blasco-Segura, P</creatorcontrib><collection>ProQuest Central (Corporate)</collection><collection>ProQuest_Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>European journal of hospital pharmacy. Science and practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ortega-Garcia, MP</au><au>Zaragozá- González, M</au><au>Pérez-Villalón, P</au><au>Gil-Gómez, I</au><au>Moya-Gil Ana, A</au><au>Gómez-Bayona, E</au><au>Laguía-Sánchez, R</au><au>Blasco-Segura, P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>4CPS-239 Therapeutic drug monitoring of gentamicin in neonates</atitle><jtitle>European journal of hospital pharmacy. Science and practice</jtitle><date>2021-03</date><risdate>2021</risdate><volume>28</volume><issue>Suppl 1</issue><spage>A34</spage><epage>A35</epage><pages>A34-A35</pages><issn>2047-9956</issn><eissn>2047-9964</eissn><abstract>Background and importancePeak (maximum plasma concentration)/MIC &gt;8–15 is a pharmacokinetic (PK)/pharmacodynamic (PD) parameter that best correlates with the effectiveness of aminoglycosides. A peak between 8 and 15 mg/L is necessary to achieve this. In neonates, doses of 3–5 mg/kg/day for the first week and 7.5 mg/kg/day from the second to the fourth week of life are recommended.Aim and objectivesTo evaluate the degree of adequacy of the initial dose with current recommendations and whether therapeutic drug monitoring (TDM) allows optimisation of treatment.Material and methodsA retrospective study was conducted from 1 January 2016 to 29 February 2020, in a general university hospital. Patients 0–35 days old treated with gentamicin and with plasma concentrations (Cp) were reviewed. The descriptive analysis was performed with the SPSSV.24 programme.Results47 patients with a median age of 3 days (0–33) were studied, 33 male. 26 (55.3%) were &lt;1 week old. 34 (72.3%) were admitted for neonatal sepsis and 7 (14.9%) for urinary infection. Gentamicin was used in combination with ampicillin in 45 cases (95.7%) and empirically in 34 (72.3%). The initially prescribed dose was 4 mg/kg/day in 36 (77%) and 5 mg/kg/day in 8 (17%), with no differences in weeks of life. Cp were extracted with a median of 2 days (1–4) after the start, the median peak was 7.5 mg/L (3.5–21.6) and 29 (62%) had a peak &lt;8 mg/L. The trough was &lt;0.2 mg/L in 26 patients and of those that were quantified, the median was 0.4 mg/L (0.2–1.3), and was higher than 1 mg/L in only one case. It was recommended to increase the dose in 26 (55.3%) and reduce it in 4 (8.5%) patients, with 90% acceptance. A second Cp determination was requested in 16 (34%) cases with a median peak of 9 mg/L (6–12) and trough levels always &lt;0.5 mg/L. It was recommended to increase the dose in 5 cases with an acceptance of 94%.Conclusion and relevanceThe dose prescribed was lower than recommended in neonates &gt;1 week old. Cp allowed detection and correction of deviations from the recommended peak or trough levels in 64% of cases, mainly due to low peak levels, with high acceptance of TDM. Plasma determination and TDM of gentamicin continues to be an essential tool to achieve the recommended PK/PD profile.References and/or acknowledgementsConflict of interestNo conflict of interest</abstract><cop>London</cop><pub>BMJ Publishing Group LTD</pub><doi>10.1136/ejhpharm-2021-eahpconf.71</doi><oa>free_for_read</oa></addata></record>
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title 4CPS-239 Therapeutic drug monitoring of gentamicin in neonates
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