Bérard E, Garraffo R, Chanalet L, Dageville C, Boutté P, Mariani R
Clinique médicale infantile, CHU de Nice, hôpital de Cimiez, France.
Arch Pediatr. 1994 May;1(5):481-8.
Neonatal bacterial infections are potentially lethal. The infant must be started on an antibiotic regimen to cover the organisms most frequently implicated. Since the introduction of gentamicin therapy for neonatal infections, attention has focused on aminoglycoside pharmacokinetics in these very young patients.
The pharmacokinetics parameters of netilmicin during its first administration were analysed in 22 newborn infants with a gestational age over 34 weeks, aged 1 to 3 days, in whom a maternofetal infection was suspected. Netilmicin was given intravenously at a dose of 6 mg/kg/day in two daily injections for 35 minutes. Blood concentrations of netilmicin were measured from samples taken 5, 15, 30, 60 minutes and 2 1/2, 5 1/5 and 11 1/2 hours after injection. The patients were also given cefotaxime plus ampicillin.
The kinetics were bicompartimental: prematurity, proven infections and other perinatal factors influenced the pharmacologic parameters and it was not possible to define a predictive formula for antibiotic administration.
The blood levels of netilmicin must be monitored even in infants who were not born prematurely. Because of the large distribution volume and the long half-life, we propose a dose of 6-7.5 mg/kg given once daily.
新生儿细菌感染可能致命。必须给婴儿开始使用抗生素方案以覆盖最常涉及的病原体。自从引入庆大霉素治疗新生儿感染以来，注意力一直集中在这些非常年幼患者的氨基糖苷类药物动力学上。
对22名胎龄超过34周、年龄1至3天、怀疑有母婴感染的新生儿首次使用奈替米星期间的药代动力学参数进行了分析。奈替米星以6毫克/千克/天的剂量静脉注射，分两次每日注射，每次35分钟。在注射后5、15、30、60分钟以及2.5、5.5和11.5小时采集血样测量奈替米星的血药浓度。这些患者还接受了头孢噻肟加氨苄西林治疗。
药代动力学为二室模型：早产、确诊感染和其他围产期因素影响药理参数，无法确定抗生素给药的预测公式。
即使对于非早产婴儿，也必须监测奈替米星的血药水平。由于分布容积大且半衰期长，我们建议每日给药一次，剂量为6 - 7.5毫克/千克。
