Aminoglycoside extended interval dosing in neonates is safe and effective: a meta-analysis

Nestaas, Eirik; Bangstad, Hans‐Jacob; Sandvik, Leiv; Wathne, Karl‐Olaf

doi:10.1136/adc.2004.056317

Cited by 100 publications

(80 citation statements)

References 30 publications

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“…In the present study, the mean trough concentrations of gentamicin in all the three weight categories were acceptable. The distributions of trough levels were the same as reported in previous studies where gentamicin was given once or twice daily at doses of 4-5 mg/kg of body-weight per day (9)(10)(11)(12)14,21). Our findings are consistent with those of Hayani et al who showed that trough concentration is not increased if a larger dose is given at a prolonged interval (9).…”

Section: Discussionsupporting

confidence: 83%

“…In our study, the mean peak concentrations around the third dose in patients weighing 2,000-2,249 g and 2,500-2,999 g were consistent with other studies of once-daily dosing of gentamicin (9,11,12,(20)(21)(22). Skopnik compared two groups of neonates who received once-and twice-daily doses of gentamicin and found that the once-daily group did better regarding efficacy and toxicity (21).…”

Section: Discussionsupporting

confidence: 79%

“…There has been recent interest in extended (e.g. daily or less frequent) dosing of aminoglycosides because higher doses given at longer intervals are likely to improve efficacy and reduce the toxic effects (9,12,14). In a developing country like Bangladesh, once-daily dosing of gentamicin can be used as an important treatment option in neonatal sepsis whereas more frequent dosing is not feasible for use in the community and peripheral health-facility settings (14,19).…”

Section: Discussionmentioning

confidence: 99%

“…Among the causative agents of neonatal sepsis, Gram-negative pathogens play a crucial role, and gentamicin is the drug of choice for first-line management. On the basis of the large volumes of distribution and slow renal clearance of aminoglycosides in neonates, larger doses based on body-weight, administered at longer intervals, are advantageous (9)(10)(11)(12). To treat neonatal sepsis more effectively in low-resource settings, it is necessary to develop a strategy for extended-interval dosing of gentamicin, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Simplified Dosing of Gentamicin for Treatment of Sepsis in Bangladeshi Neonates

Hossain

Chowdhury

Shirin

et al. 2009

J Health Popul Nutr

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Extended-interval dosing of gentamicin has several advantages over conventional multiple-daily dosing for the treatment of sepsis. The study was conducted to evaluate the pharmacokinetics of gentamicin for the treatment of neonatal sepsis in predetermined doses at 24-or 48-hour intervals, according to weight category, and to develop a simplified protocol for use in peripheral healthcare settings in developing countries. This prospective observational study was conducted among 59 neonates admitted to the Special Care Nursery at Dhaka Shishu Hospital, Bangladesh, with suspected sepsis and treated with antibiotics, including gentamicin. Intravenous dosing of gentamicin according to weight category was: 10 mg every 48 hours if the infant weighed <2,000 g (n=23), 10 mg every 24 hours if the infant weighed 2,000-2,249 g (n=12), or 13.5 mg every 24 hours if the infant weighed 2,500-3,000 g (n=24). Peak and trough concentrations of gentamicin and the presence of signs of nephrotoxicity and ototoxicity were determined. The mean±standard deviation peak concentration of gentamicin was 12.3±3.7 µg/mL in infants weighing <2,000 g, 9.6±3.1 µg/mL in infants 2,000-2,249 g, and 10.0±3.4 µg/mL in infants 2,500-3,000 g. Initial peak concentration of gentamicin was >12 µg/mL in 28.8% and initial trough concentration was >2 µg/mL in 6.8% of the subjects. No signs of nephrotoxicity or ototoxicity were detected. Favourable pharmacokinetic parameters found with the simplified dosing regimen suggest that it is safe for the treatment of neonatal sepsis.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Simplified Dosing of Gentamicin for Treatment of Sepsis in Bangladeshi Neonates

Hossain

Chowdhury

Shirin

et al. 2009

J Health Popul Nutr

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“…The most common reason cited for not using EIAG in this survey was a lack of supporting efficacy data, which was identified by nearly 60 % of hospitals. Reviews and meta-analyses have summarized neonatal and pediatric EIAG efficacy data [8,9,26,27]. Given the available efficacy data, the high percentage of respondents describing the lack of supporting efficacy data as a barrier is surprising.…”

Section: Discussionmentioning

confidence: 99%

Optimized Antimicrobial Dosing Strategies: A Survey of Pediatric Hospitals

2014

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Abstract:Background Extended-interval aminoglycoside (EIAG) and extended-and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited. ObjectiveThe objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA. Study Design, Setting, and ParticipantsA national survey of children's hospitals was conducted. A single practitioner from each target hospital was identified through the Children's Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing. Main Outcome MeasureThe main outcome measure was the percentage utilization of the dosing strategies, with secondary outcomes being the reasons for not using these dosing strategies. ResultsSeventy-seven of 215 identified practitioners (36 %) participated in the survey. EIAG, EIBL, and CIBL dosing were utilized in 63 %, 24 %, and 13 % of responding hospitals, respectively. The most common reasons for not using EIAG were concern regarding lack of efficacy data (56 %) and concern regarding the duration of the drug-free period (41 %). Respondents who did not utilize EIBL cited concern due to lack of pediatric EIBL efficacy data (54 %), the need for more intravenous access (54 %), intravenous medication compatibility issues (39 %), and the time during which the patient is attached to an intravenous infusion (31 %). ConclusionThis survey of children's hospitals indicates that EIAG is used in over 50 % of hospitals, but there is some lag in adoption of EIBL and CIBL dosing, both of which are used in fewer than 25 % of hospitals.Additional studies may provide much-needed evidence to increase the utilization of these strategies.2

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