Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
Am J Health Syst Pharm. 2012 Aug 1;69(15):1319-25. doi: 10.2146/ajhp110276.
The results of a study to identify factors associated with serum gentamicin levels outside the therapeutic range in a neonatal population are reported.
A single-center retrospective chart review was conducted to identify cases involving gentamicin use in the neonatal intensive care unit; a sample of cases sufficient for risk-factor analysis (n = 225) was selected for evaluation. In all evaluated cases, gentamicin was administered according to a standardized dosing protocol based on gestational age and weight. Selected clinical factors and laboratory values potentially associated with undesirably high or low serum drug levels were analyzed.
Of the 225 patient cases included in the analysis, 184 (82%) involved appropriate (i.e., per protocol) gentamicin dosing. Of the 41 doses classified as inappropriate, 33 were higher and 8 were lower than those recommended by the protocol. Six (18%) of the newborns who received doses classified as inappropriately high had supratherapeutic serum trough concentrations, and 3 (9%) had subtherapeutic trough values. Among the neonates with supratherapeutic peak values, none had an elevated trough value and only 1 received a gentamicin dose deemed to be inappropriately high. Factors associated with an increased relative risk (RR) of a supratherapeutic trough included inappropriate dosing (RR, 2.9; 95% confidence interval [CI], 1.18-6.9), an elevated serum creatinine (SCr) concentration (>0.8 mg/dL) on the day of blood sampling for drug level assessment (RR, 25.6; 95% CI, 9.1-71.4), low urine output (<1 mL/kg/hr) on the day of blood sampling (RR, 7.8; 95% CI, 3.0-15.4), and shock (RR, 3.16; 95% CI, 1.32-7.57).
When adhering to a weight-based gentamicin dosing protocol, the SCr level and urine output are the best indicators for identifying neonatal patients at risk for supratherapeutic gentamicin trough levels. Shock and inappropriate dosing strategies also put patients at increased risk for supratherapeutic troughs.
报告了一项研究的结果，该研究旨在确定与新生儿人群血清庆大霉素水平超出治疗范围相关的因素。
进行了一项单中心回顾性图表审查，以确定新生儿重症监护病房使用庆大霉素的病例；选择了足够进行危险因素分析的病例样本（n=225）进行评估。在所有评估的病例中，根据基于胎龄和体重的标准化剂量方案给予庆大霉素。分析了与血清药物水平不理想升高或降低相关的选定临床因素和实验室值。
在纳入分析的 225 例患者病例中，184 例（82%）的庆大霉素给药方案符合规定（即符合方案）。在归类为不适当的 41 个剂量中，有 33 个剂量高于方案推荐剂量，8 个剂量低于方案推荐剂量。接受归类为剂量过高的新生儿中，有 6 例（18%）出现治疗窗内谷浓度过高，有 3 例（9%）出现治疗窗内谷浓度过低。在出现治疗窗内峰浓度过高的新生儿中，无一例出现谷浓度升高，仅有 1 例接受的庆大霉素剂量被认为不适当。与治疗窗内谷浓度升高的相对风险（RR）增加相关的因素包括不适当的给药（RR，2.9；95%置信区间[CI]，1.18-6.9）、血样采集当天血清肌酐（SCr）浓度升高（>0.8mg/dL）（RR，25.6；95%CI，9.1-71.4）、血样采集当天尿量减少（<1ml/kg/hr）（RR，7.8；95%CI，3.0-15.4）和休克（RR，3.16；95%CI，1.32-7.57）。
当遵循基于体重的庆大霉素剂量方案时，SCr 水平和尿量是识别有发生庆大霉素治疗窗内谷浓度过高风险的新生儿患者的最佳指标。休克和不适当的给药策略也使患者面临更高的治疗窗内谷浓度过高风险。
