A comparison of ceftazidime and aminoglycoside based regimens as empirical treatment in 1316 cases of suspected sepsis in the newborn

Louvois, J de; Dagan, Ron; Tessin, Ingemar

doi:10.1007/bf01954122

Cited by 39 publications

(10 citation statements)

References 19 publications

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“…Aminoglycosides also play an important role in the initial empiric treatment of neonatal septicemia. 6 Various regimens for dose, dosing interval, and monitoring have been suggested and imple-CLINICAL PHARMA COLOGY & THERAPEUTICS VOLUME 62, NUMBER 4 de Haag et al 393 mented over the last two decades.7-14 A significant relation between gestational age and the need for prolonged dosing intervals was established, and the more recent dosing regimens propose once daily dosing of aminoglycosides in very low birth weight infants. "-i5 However, we had the impression that high trough levels were frequently encountered in these infants even with once daily administration of aminoglycosides.…”

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confidence: 99%

Vancomycin population pharmacokinetics in neonates

Hoog

Schoemaker

Mouton

et al. 2000

Clinical Pharmacology & Therapeutics

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confidence: 99%

Vancomycin population pharmacokinetics in neonates

Hoog

Schoemaker

Mouton

et al. 2000

Clinical Pharmacology & Therapeutics

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“…6 Various regimens for dose, dosing interval, and monitoring have been suggested and imple-CLINICAL PHARMA COLOGY & THERAPEUTICS VOLUME 62, NUMBER 4 de Haag et al 393…”

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confidence: 99%

Tobramycin population pharmacokinetics in neonates*

Hoog

Schoemaker

Mouton

et al. 1997

Clin Pharmacol Ther

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Objective: To establish a tobramycin dosing schedule for neonates of various gestational ages. Methods: This was a retrospective study with prospective validation. A retrospective study in 470 neonates, with suspected septicemia in the first week of life, was performed.All patients received tobramycin according to the following scheme: neonates with a gestational age of less than 28 weeks received 3.5 mg/kg every 24 hours, neonates from 28 to 36 weeks received 2.5 mg/kg every 18 hours, neonates older than 36 weeks received 2.5 mg/kg every 12 hours. Trough and peak tobramycin serum levels were determined before drug administration and 30 minutes after the fourth dose. Tobramycin data were analyzed according to a one-compartment open model with use of NONMFJM population pharmacokinetic software. Individual empirical Bayes estimates were generated on the basis of the population estimates and used to calculate predicted peak and trough levels for different doses and dosing intervals. To establish au optimal dosing regimen, target trough levels were set at below 2 mg/L and target peak levels were set above 5 to 10 mg/L. The dosing regimen was prospectively evaluated in 23 patients. Results: Of the 470 patients, 19.1% of measured peak and 32.8% of measured trough tobramycin serum levels were outside the desired therapeutic range, and 48.8% of neonates with a gestational age of less than 28 weeks had an aberrant trough level. With use of population estimates, the following dosing regimen was recommended:gestational age below 32 weeks, 4 mg/kg every 48 hours; gestational age between 32 and 37 weeks, 4 mg/kg every 36 hours, gestational age above 37 weeks, 4 mg/kg every 24 hours. With this dosing schedule, predicted peak levels were higher than 5 mg/L in 95.1% of the neonates. Predicted trough levels were higher than 2 mg/L in 1.9% of the neonates and higher than 1 mg/L in 7.6%. Prospectively measured peak levels were higher than 5 mg/L in all but one infant. Measured trough levels were higher than 2 mg/L in three patients and marginally higher than 1 mg/L in four patients. Concl&ons:With the use of this proposed schedule, taking into account differences in gestational ages, predicted peak levels will be therapeutic, whereas predicted trough levels will minimize toxicity. (

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“…Initial empiric treatment with a combination of an aminoglycoside with penicillin, amoxicillin (INN, amoxicilline), or a cephalosporin is common practice. 7 Optimization of aminoglycoside use in neonates warrants therapeutic drug monitoring (TDM) for both efficacy and toxicity reasons. Aminoglycoside efficacy is related to the ratio of peak serum concentration with the minimal inhibitory concentration of the infecting microorganism and the area under the time-versus-concentration curve (AUC).…”

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confidence: 99%

“…9 Toxicity is related to high predose concentrations, and serum trough concentrations should be in the range of 0.5 to 2 mg/L, depending on the dosing interval. 7,10,11 Traditionally, TDM for aminoglycosides has been performed during steady-state conditions around the fourth dose. For several reasons this is not useful in neonates during the first week of life.…”

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confidence: 99%