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Published on: November 11, 2014
Once daily dosing of netilmicin in neonatal and pediatric intensive care
1Intensive Care Unit, University Children's Hospital, Inselspital, Bern, Switzerland.
Insights
Once daily netilmicin dosing in critically ill neonates and children achieved optimal therapeutic levels. This dosing regimen, adjusted for age and kidney function, is effective for managing serious infections.
Area of Science:
- Pediatric Pharmacology
- Neonatal Intensive Care
- Infectious Disease Management
Background:
- Aminoglycosides like netilmicin are crucial for treating severe infections in critically ill neonates and children.
- Optimizing dosing regimens is essential to maximize efficacy and minimize toxicity in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy and safety of a once-daily dosing strategy for netilmicin in critically ill pediatric and neonatal patients.
- To determine if this simplified dosing schedule can achieve therapeutic drug concentrations.
Main Methods:
- An open, prospective study involving 81 antibiotic courses in 77 critically ill neonates and children.
- Netilmicin was administered intravenously once every 24 hours, with doses adjusted based on gestational and postnatal age.
- Peak and trough drug levels were monitored to assess therapeutic targets.
Main Results:
- All measured peak netilmicin levels exceeded the target of 12 mumol/l (mean 22 mumol/l).
- The majority of trough levels (89 out of 100) were within the desired range (< 4 mumol/l).
- Elevated trough levels were infrequent (11%) and primarily associated with impaired renal function.
Conclusions:
- Once-daily administration of netilmicin is a viable strategy for critically ill neonates and children.
- Therapeutic drug levels can be consistently achieved by adapting the dose to gestational/postnatal age and renal function.
Objective:
To examine a once daily dosing regimen of netilmicin in critically ill neonates and children.
Design And Setting:
Open, prospective study on 81 antibiotic courses in 77 critically ill neonates and children, hospitalized in a multidisciplinary pediatric/neonatal intensive care unit. For combined empiric therapy (aminoglycoside and beta-lactam), netilmicin was given intravenously over 5 min once every 24 h. The dose ranged from 3.5-6 mg/kg, mainly depending upon gestational and postnatal age. Peak levels were determined by immunoassay 30 min after the second dose and trough levels 1 h before the third and fifth dose or after adaptation of dosing.
Results:
All peak levels (n = 28) were clearly above 12 mumol/l (mean 22, range 13-41 mumol/l). Eighty-nine trough levels were within desired limits (< 4 mumol/l) and 11 (11%) above 4 mumol/l, mostly in conjunction with impaired renal function.
Conclusions:
Optimal peak and trough levels of netilmicin can be achieved by once daily dosing, adapted to gestational/postnatal age and renal function.
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