Hurkacz Magdalena, Nowakowska Joanna Monika, Paluszyńska Dorota, Królak-Olejnik Barbara
Department of Clinical Pharmacology, Wrocław Medical University, Wrocław, Poland.
Department and Clinic of Neonatology, Wrocław Medical University, Wrocław, Poland.
Dev Period Med. 2019;23(1):21-27. doi: 10.34763/devperiodmed.20192301.2127.
Aim: To evaluate how useful it is to make measurements of gentamicin concentrations in newborns' blood in order to optimize antibiotic therapy.
Material and methods: 73 newborns empirically treated with gentamicin, in doses consistent with the Neofax® guidelines. There were 152 measurements of maximum and minimum serum gentamicin concentrations. Samples were determined based on the chemiluminescence technique on the Siemens Advia Centaur analyzer. The concentrations of gentamicin that were measured were compared with various therapeutic ranges used in the literature.
Results: According to the standards adopted in the University Hospital in Wrocław, the maximum concentration was reached in 38.16% of all the children, while the minimum in 26.32%. In other children the concentrations were below or above the therapeutic range. According to the Neofax® guidelines, the intended maximum concentration was observed in 71.05% of the newborns, and the minimum in 32.89%. The minimum concentration of <2 mg/L was found in 93.42% of the newborns, while >2 mg/L was determined in 33.33%, despite a 48-hour dosing interval. These were premature babies (<28th week of gestational age) and 55.56% of them reached a maximum concentration of 5-12 mg/L. There was no significant correlation between maximum or minimum concentration and gestational age or body weight.
Conclusions: 1. The dosage of gentamicin in newborns according to the Neofax® recommendations does not ensure achieving the intended serum antibiotic concentrations. 2. In order to optimize gentamicin therapy in newborns it is necessary to individualize the dose based on measurements of drug concentrations in the blood and pharmacokinetic calculations.
评估检测新生儿血液中庆大霉素浓度对优化抗生素治疗的有用程度。
73例新生儿接受经验性庆大霉素治疗，剂量符合《新生儿药物手册》（Neofax®）指南。共进行了152次血清庆大霉素最高和最低浓度检测。样本采用西门子Advia Centaur分析仪上的化学发光技术进行测定。将测得的庆大霉素浓度与文献中使用的各种治疗范围进行比较。
根据弗罗茨瓦夫大学医院采用的标准，所有儿童中38.16%达到最高浓度，26.32%达到最低浓度。其他儿童的浓度低于或高于治疗范围。根据《新生儿药物手册》（Neofax®）指南，71.05%的新生儿观察到预期的最高浓度，32.89%观察到最低浓度。尽管给药间隔为48小时，但93.42%的新生儿最低浓度<2mg/L，33.33%的新生儿最低浓度>2mg/L。这些是早产儿（胎龄<28周），其中55.56%的最高浓度达到5 - 12mg/L。最高或最低浓度与胎龄或体重之间无显著相关性。
