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Dose Optimization of Gentamicin in Critically Ill Neonates

[ Vol. 21 , Issue. 4 ]

Author(s):

Kannan Sridharan*, Muna Al Jufairi, Ali Mohamed Qader and Ola A.M. Elsegai   Pages 270 - 280 ( 11 )

Abstract:


Background: Appropriate dosing of gentamicin in critically ill neonates is still debated.

Objective: To assess the peak concentration (Cmax) and area-under-the-time-concentration curve (AUC0-24) of gentamicin and to simulate the recommended doses using the Monte Carlo method.

Methods: This was a retrospective study on critically ill neonates carried over a one-year period. The demographic characteristics, dosage regimen and gentamicin concentrations were recorded for each neonate. Using Bayesian pharmacokinetic modeling, Cmax and AUC0-24 were predicted. Dose recommendations for the target Cmax (μg/ml) of 12 were obtained, and Monte Carlo simulation (100,000 iterations) was used for predicting the pharmacokinetic parameters and recommended doses for various birth weight categories.

Results: Eighty-two critically ill neonates (with an average gestational age of 33.7 weeks; and birth weight of 2.1 kg) were recruited. Higher Cmax and AUC0-24 values were predicted in premature neonates, with greater cumulative AUCs in extremely preterm neonates. The average administered dose was 4 mg/kg/day and 75% of the participants had Cmax greater than 12 μg/ml following a single dose, and 85% were found to be at steady state. On the contrary, only 25% of the study population had the recommended AUC0-24 (above 125 μg-hr/ml). Simulation tests indicate that 90% of the critically ill neonates would achieve recommended Cmax with doses ranging between 5 and 6 mg/kg/day.

Conclusion: Currently used dose of 4 mg/kg/day is adequate to maintain Cmax in a large majority of the study population, with one-fourth population reporting the recommended AUC0-24. Increasing the dose to 5-6 mg/kg/day will more likely help to achieve both the recommended Cmax and AUC0-24 values.

Keywords:

Aminoglycosides, clinical pharmacokinetics, gentamicin, Bayesian, Monte Carlo simulations, dosing strategy.

Affiliation:

Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Department of Pediatrics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Department of Pathology-Biochemistry, Salmaniya Medical Hospital, Ministry of Health, Manama

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