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Bajaber AN, Elrggal M, Organji WF, Sulaimani MA, Refai RM, Alsaedi A, Alzamzami SH, Hawsawi FB, Alnefaie ST, Alsulaimani AA, Alharbi A, Alnuhait M, Alshammari AS, Aldarhami A, Sharaf SE. Evaluating Adherence to Therapeutic Drug Monitoring Guidelines for Gentamicin in Neonatal Care: A Retrospective Study at the Maternity and Children's Hospital in Makkah. CHILDREN (BASEL, SWITZERLAND) 2024; 11:100. [PMID: 38255413 PMCID: PMC10814964 DOI: 10.3390/children11010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
In this study, we assess healthcare providers' adherence to therapeutic drug monitoring (TDM) guidelines for gentamicin in neonates. Conducted at the Maternity and Children's Hospital in Makkah, Saudi Arabia, from July 2020 to July 2022, it retrospectively analyzed the compliance of healthcare workers in managing neonates treated with gentamicin. Covering 410 neonates, primarily diagnosed with respiratory distress (56%) and sepsis (32%), the study revealed that while a majority of trough and peak levels conformed to guidelines, substantial deviations were noted in cases of respiratory distress. This underlines the necessity for targeted TDM strategies, particularly in managing respiratory distress in neonates, to ensure optimal treatment efficacy and safety. The findings urge stringent compliance with TDM guidelines, emphasizing personalized approaches in neonatal gentamicin therapy for improved healthcare outcomes.
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Affiliation(s)
- Abdullah Najeh Bajaber
- Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia; (A.N.B.); (W.F.O.); (M.A.S.); (R.M.R.); (A.A.); (S.H.A.); (F.B.H.); (S.T.A.); (A.A.A.)
| | - Mahmoud Elrggal
- Pharmacology & Toxicology Department, Faculty of Medicine, Al Qunfudah, Umm Al-Qura University, Makkah 21961, Saudi Arabia
| | - Wajdi F. Organji
- Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia; (A.N.B.); (W.F.O.); (M.A.S.); (R.M.R.); (A.A.); (S.H.A.); (F.B.H.); (S.T.A.); (A.A.A.)
| | - Mohammad Adil Sulaimani
- Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia; (A.N.B.); (W.F.O.); (M.A.S.); (R.M.R.); (A.A.); (S.H.A.); (F.B.H.); (S.T.A.); (A.A.A.)
| | - Raed Mohammed Refai
- Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia; (A.N.B.); (W.F.O.); (M.A.S.); (R.M.R.); (A.A.); (S.H.A.); (F.B.H.); (S.T.A.); (A.A.A.)
| | - Ashraf Alsaedi
- Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia; (A.N.B.); (W.F.O.); (M.A.S.); (R.M.R.); (A.A.); (S.H.A.); (F.B.H.); (S.T.A.); (A.A.A.)
| | - Salwa Hashim Alzamzami
- Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia; (A.N.B.); (W.F.O.); (M.A.S.); (R.M.R.); (A.A.); (S.H.A.); (F.B.H.); (S.T.A.); (A.A.A.)
| | - Fatimah Bakor Hawsawi
- Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia; (A.N.B.); (W.F.O.); (M.A.S.); (R.M.R.); (A.A.); (S.H.A.); (F.B.H.); (S.T.A.); (A.A.A.)
| | - Saud Tanadhub Alnefaie
- Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia; (A.N.B.); (W.F.O.); (M.A.S.); (R.M.R.); (A.A.); (S.H.A.); (F.B.H.); (S.T.A.); (A.A.A.)
| | - Azhar Ali Alsulaimani
- Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia; (A.N.B.); (W.F.O.); (M.A.S.); (R.M.R.); (A.A.); (S.H.A.); (F.B.H.); (S.T.A.); (A.A.A.)
| | - Adnan Alharbi
- Pharmaceutical Practices Department, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.A.); (M.A.); (A.S.A.)
| | - Mohammed Alnuhait
- Pharmaceutical Practices Department, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.A.); (M.A.); (A.S.A.)
| | - Abdullah S. Alshammari
- Pharmaceutical Practices Department, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.A.); (M.A.); (A.S.A.)
| | - Abdu Aldarhami
- Department of Medical Microbiology, Faculty of Medicine, Al Qunfudah, Umm Al-Qura University, Makkah 21961, Saudi Arabia;
| | - Sharaf E. Sharaf
- Pharmaceutical Sciences Department, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
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Rezende RQ, Dias CAG, Ricachinevsky CP, de Lucena Capelari JP. Impact of the Implementation of a Vancomycin Protocol on Trough Serum Vancomycin Concentrations in a Pediatric Intensive Care Unit. Paediatr Drugs 2021; 23:299-305. [PMID: 33830468 DOI: 10.1007/s40272-021-00445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vancomycin is an antibiotic that is widely used in pediatric intensive care, but the safe and effective use of this drug is challenging. OBJECTIVE This study aimed to assess the impact of a vancomycin protocol on trough serum concentrations. METHODS We conducted a retrospective quasiexperimental study in patients aged ≤ 18 years in intensive care who received vancomycin for at least 5 days. Patients were divided into two groups: before and after a protocol implemented in 2017 that suggested an initial vancomycin dose of 60 mg/kg/day, target serum levels of 15-20 μg/mL, and dose adjustments. We compared patient characteristics, target serum level achievement, and vancomycin levels over time. RESULTS Each group contained 65 patients; most were male infants with heart disease as the main reason for hospitalization. Only 29.2% of the patients had pretreatment cultures for bacteria identification recorded, with 1.5% identified as methicillin-resistant Staphylococcus aureus. For the first serum levels, 10.8% of patients in the pre-protocol group and 21.5% in the post-protocol group achieved the 15-20 μg/mL target (p = 0.153); during the first 5 days of treatment, this proportion significantly increased from 52.3 to 73.8% (p = 0.018). We observed a difference between the first and fifth levels: 8.9 μg/mL (95% confidence interval [CI] - 3.1 to 21) pre-protocol and 0.4 μg/mL (95% CI - 6.1 to 6.9) post-protocol (p = 0.175). CONCLUSIONS Reaching adequate trough vancomycin concentrations in critically ill pediatric patients remains a challenge, and clinical practice protocols allow better dose adjustment and control even when monitoring technologies are unavailable.
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Affiliation(s)
- Raíssa Queiroz Rezende
- Pediatric Intensive Care Unit, Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Avenida Independência, 155, Porto Alegre, RS, CEP 90035-074, Brazil.
| | - Cícero Armídio Gomes Dias
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Claudia Pires Ricachinevsky
- Pediatric Intensive Care Unit, Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Avenida Independência, 155, Porto Alegre, RS, CEP 90035-074, Brazil
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Keij FM, Achten NB, Tramper-Stranders GA, Allegaert K, van Rossum AMC, Reiss IKM, Kornelisse RF. Stratified Management for Bacterial Infections in Late Preterm and Term Neonates: Current Strategies and Future Opportunities Toward Precision Medicine. Front Pediatr 2021; 9:590969. [PMID: 33869108 PMCID: PMC8049115 DOI: 10.3389/fped.2021.590969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/01/2021] [Indexed: 12/20/2022] Open
Abstract
Bacterial infections remain a major cause of morbidity and mortality in the neonatal period. Therefore, many neonates, including late preterm and term neonates, are exposed to antibiotics in the first weeks of life. Data on the importance of inter-individual differences and disease signatures are accumulating. Differences that may potentially influence treatment requirement and success rate. However, currently, many neonates are treated following a "one size fits all" approach, based on general protocols and standard antibiotic treatment regimens. Precision medicine has emerged in the last years and is perceived as a new, holistic, way of stratifying patients based on large-scale data including patient characteristics and disease specific features. Specific to sepsis, differences in disease susceptibility, disease severity, immune response and pharmacokinetics and -dynamics can be used for the development of treatment algorithms helping clinicians decide when and how to treat a specific patient or a specific subpopulation. In this review, we highlight the current and future developments that could allow transition to a more precise manner of antibiotic treatment in late preterm and term neonates, and propose a research agenda toward precision medicine for neonatal bacterial infections.
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Affiliation(s)
- Fleur M Keij
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.,Department of Pediatrics, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands
| | - Niek B Achten
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Gerdien A Tramper-Stranders
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.,Department of Pediatrics, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands
| | - Karel Allegaert
- Department of Development and Regeneration, Department of Pharmaceutical and Pharmacological Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Clinical Pharmacy, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Annemarie M C van Rossum
- Division of Infectious Diseases, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - René F Kornelisse
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
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