PRESCRIBING AND MONITORING OF GENTAMICIN IN NEONATES

To evaluate the implementation of the National Institute for Health and Care Excellence (NICE) clinical guideline1 with regards to the prescribing, exposure and therapeutic drug level monitoring of gentamicin in early onset neonatal infection.

A selection of drug charts for babies who were prescribed gentamicin within 72 hrs of birth were reviewed. The number of doses of gentamicin administered, C-reactive protein (CRP) results, blood culture results and gentamicin trough levels were recorded. A new gentamicin prescription chart was developed based on the NICE clinical guideline1 and the National Patient Safety Agency (NPSA) alert2 on the safer use of gentamicin for neonates, and was launched on the Neonatal Intensive Care Unit (NICU). A number of months after the new gentamicin prescription chart was introduced, and had therefore had time to become embedded into practice, a selection of babies' drug charts were reviewed and the same information as previously was documented. The information obtained before and after the introduction of the new gentamicin prescription chart was compared.

Prior to the new gentamicin prescription chart 16 prescriptions for gentamicin were reviewed, and in total 47 doses of gentamicin were administered. Blood cultures were negative after five days in all 16 patients. In total 9 gentamicin trough levels were taken with only one level being >2 mg/L. Following the introduction of the new prescription chart another 16 prescriptions for gentamicin were reviewed, and in total 38 doses of gentamicin were administered. Again blood cultures were negative after five days in all 16 patients. In total 14 gentamicin trough levels were taken with two levels being >2 mg/L. Prior to the new gentamicin prescription chart 50% of babies received more than one dose of gentamicin despite having two CRP results <10. This is compared to 31% of babies following the introduction of the new gentamicin prescription chart.

It can be concluded that the new gentamicin prescription chart has resulted in a reduction in the exposure of babies to gentamicin, as all babies now have it administered at 36 hourly intervals. There has also been an increase in blood monitoring of trough gentamicin levels, as they are now taken prior to the second dose rather than the third dose. Therefore the new gentamicin prescription chart is safer as toxic levels are identified sooner, which reduces the risk of babies suffering adverse effects.Since the introduction of the new gentamicin prescription chart 31% of babies received more than the necessary number of gentamicin doses, as dictated by the CRP results and blood culture result at 36 hrs. This is a learning point which will be highlighted to the medical and nursing staff on NICU.