Session 2The impact of therapeutic drug monitoring in neonatal clinical pharmacology
Introduction
Optimal administration of aminoglycosides (both used in early and late onset sepsis) and vancomycin (primarily used in late onset infections) in neonatal intensive care units (NICUs) will profit from the appropriate use of therapeutic drug monitoring (TDM). All health care providers involved in care for neonates need to understand the principles of TDM. Therefore a close working relationship between specialists in neonatal medicine, nurse practitioners, physician-assistants, pharmacists and pediatric pharmacologists is necessary. Irrespective of the antibacterial agents that are being used for the treatment of diverse infectious diseases it is important to focus at the pharmacokinetic/pharmacodynamic (PK/PD) relationship of these agents. This presentation will aim solely at aminoglycosides and vancomycin. Aminoglycosides are still one of the most commonly used antibiotics in NICUs across the world despite the fact that they belong to one of the oldest classes of antimicrobial agents and have been in use since the mid-1940. There are various factors that have contributed to their success such as a low rate of resistance and a low cost. Vancomycin became the drug of choice for staphylococcal infections in the 1950s, when staphylococcal strains developed resistance to penicillin. It was replaced by methicillin in the 1960s, but when the incidence of late onset neonatal sepsis due to coagulase negative staphylococci and methicillin-resistant staphylococci increased, vancomycin use increased too and vancomycin is currently the drug of choice for the treatment of resistant neonatal staphylococcal infections.
Section snippets
Administration of antibacterial agents in the NICU
The intravenous administration of drugs is the preferred route in neonates. In very small and premature infants the total body water compartment may be 85% of the total body weight with a very high proportion being extracellular fluid. This high proportion of extracellular fluid is a very important parameter that explains that the volume of distribution of hydrophilic drugs is very high in neonates.
As an example, the volume of distribution of aminoglycosides is much larger than that in older
Conclusion
Safe and effective use of antibacterial agents in neonates will depend on several important issues such as application of modeling and simulation techniques to optimize dosing regimens of antimicrobial agents for use in the newborn population, consensus on what dose and dosing regimen to use in NICUs and a continuous electronic update on new insights in this important area, and finally reporting of new data on short- and long-term side effects of the use of these important antibacterial agents
References (3)
- et al.
High dose gentamicin in newborn infants: is it safe?
Eur J Pediatr
(Nov 14 2013)
Cited by (1)
Therapeutic drug monitoring in neonates
2016, Archives of Disease in Childhood