Pediatrics & Neonatology, Alberta Health Services, Calgary, Canada.
Ann Pharmacother. 2012 Jul-Aug;46(7-8):935-42. doi: 10.1345/aph.1R029. Epub 2012 Jun 26.
Extended-interval aminoglycoside dosing is increasingly used in neonates; however, guidance on how to monitor concentrations and adjust dosages accordingly is limited.
To prospectively validate the use of a 22-hour gentamicin concentration dosing table for the individualization of extended-interval dosing in the neonatal population by examining the peak and trough concentrations achieved through its use.
A prospective observational study was carried out on gentamicin concentrations achieved using a 22-hour post-first-dose gentamicin concentration dosing table for determining dosing intervals in neonates. Neonates (N = 104) in the first week of life, gestational age 23 weeks to full term, in level II and III neonatal intensive care units were included. Neonates were given gentamicin 5 mg/kg intravenously; a table using 22-hour post-first-dose gentamicin concentrations was then used to individualize dosing intervals. Pre- and post-serum gentamicin concentrations on the dosing interval indicated were measured with the second or third doses and used to calculate the peak and trough concentrations achieved.
Use of the 22-hour post-first-dose gentamicin concentration dosing table resulted in dosing intervals that provided appropriate peak (mean 10.55 mg/L) and trough (mean 0.75 mg/L) concentrations (with second or third doses) in all neonates. All patients had trough concentrations less than 2 mg/L, and 73% had a trough concentration less than 1 mg/L. No peak concentrations were less than 5 mg/L, 82% of patients had a peak concentration from 5 to 12 mg/L, and the remaining 18% had concentrations from 12.1 to 16 mg/L. Peak and trough concentrations were similar across all gestational ages.
Use of a 22-hour post-first-dose gentamicin concentration dosing table to individualize extended-interval gentamicin dosages in neonates resulted in appropriate peak and trough concentrations in all neonates studied. Use of this table will result in appropriate extended-interval aminoglycoside dosages in neonates early in treatment, using a single serum concentration.
延长间隔氨基糖苷类药物给药在新生儿中越来越常用；然而，关于如何监测浓度并相应调整剂量的指导有限。
通过检查使用该方法获得的峰浓度和谷浓度，前瞻性验证在新生儿人群中使用 22 小时庆大霉素浓度给药表来个体化延长间隔给药。
对使用 22 小时首剂量后庆大霉素浓度给药表确定新生儿给药间隔的 104 例新生儿（胎龄 23 周至足月，在二级和三级新生儿重症监护病房）的庆大霉素浓度进行前瞻性观察研究。新生儿接受 5mg/kg 静脉注射庆大霉素；然后使用 22 小时首剂量后庆大霉素浓度给药表个体化给药间隔。在指示的给药间隔上测量第 2 或第 3 次剂量前和后的血清庆大霉素浓度，并用于计算达到的峰浓度和谷浓度。
使用 22 小时首剂量后庆大霉素浓度给药表可使所有新生儿的给药间隔提供适当的峰浓度（均值 10.55mg/L）和谷浓度（均值 0.75mg/L）（用第 2 或第 3 次剂量测量）。所有患者的谷浓度均低于 2mg/L，73%的患者谷浓度低于 1mg/L。无峰浓度低于 5mg/L，82%的患者峰浓度在 5-12mg/L 之间，其余 18%的患者峰浓度在 12.1-16mg/L 之间。各胎龄组的峰浓度和谷浓度相似。
在新生儿中个体化延长间隔庆大霉素剂量时使用 22 小时首剂量后庆大霉素浓度给药表可使所有研究中的新生儿达到适当的峰浓度和谷浓度。使用该表将使新生儿在治疗早期，通过单次血清浓度获得适当的延长间隔氨基糖苷类药物剂量。
