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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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Mendoza-Palomar N, Vima J, Soler-Palacin P, Castillo-Salinas F. Antimicrobial therapeutic drug monitoring in a high-complexity neonatal intensive care unit within a paediatric antibiotic stewardship program. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:58-59. [PMID: 36621249 DOI: 10.1016/j.eimce.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/23/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Natalia Mendoza-Palomar
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Mother and Child Area, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Pediatric Antibiotic Stewardship Program (PROA-NEN), Mother and Child Area, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jaume Vima
- Vall d'Hebron Research Institute, Barcelona, Spain; Special Biochemistry Laboratory, Central Clinical Laboratories, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Mother and Child Area, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Pediatric Antibiotic Stewardship Program (PROA-NEN), Mother and Child Area, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain.
| | - Félix Castillo-Salinas
- Pediatric Antibiotic Stewardship Program (PROA-NEN), Mother and Child Area, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain; Neonatology Department, Mother and Child Area, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Antimicrobial therapeutic drug monitoring in a high-complexity neonatal intensive care unit within a paediatric antibiotic stewardship program. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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De Rose DU, Cairoli S, Dionisi M, Santisi A, Massenzi L, Goffredo BM, Dionisi-Vici C, Dotta A, Auriti C. Therapeutic Drug Monitoring Is a Feasible Tool to Personalize Drug Administration in Neonates Using New Techniques: An Overview on the Pharmacokinetics and Pharmacodynamics in Neonatal Age. Int J Mol Sci 2020; 21:E5898. [PMID: 32824472 PMCID: PMC7460644 DOI: 10.3390/ijms21165898] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
Therapeutic drug monitoring (TDM) should be adopted in all neonatal intensive care units (NICUs), where the most preterm and fragile babies are hospitalized and treated with many drugs, considering that organs and metabolic pathways undergo deep and progressive maturation processes after birth. Different developmental changes are involved in interindividual variability in response to drugs. A crucial point of TDM is the choice of the bioanalytical method and of the sample to use. TDM in neonates is primarily used for antibiotics, antifungals, and antiepileptic drugs in clinical practice. TDM appears to be particularly promising in specific populations: neonates who undergo therapeutic hypothermia or extracorporeal life support, preterm infants, infants who need a tailored dose of anticancer drugs. This review provides an overview of the latest advances in this field, showing options for a personalized therapy in newborns and infants.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.S.); (A.D.)
| | - Sara Cairoli
- Laboratory of Metabolic Biochemistry Unit, Department of Specialist Pediatrics, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (S.C.); (M.D.); (B.M.G.); (C.D.-V.)
| | - Marco Dionisi
- Laboratory of Metabolic Biochemistry Unit, Department of Specialist Pediatrics, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (S.C.); (M.D.); (B.M.G.); (C.D.-V.)
| | - Alessandra Santisi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.S.); (A.D.)
| | - Luca Massenzi
- Neonatal Intensive Care Unit and Neonatal Pathology, Fatebenefratelli Hospital, 00186 Rome, Italy;
| | - Bianca Maria Goffredo
- Laboratory of Metabolic Biochemistry Unit, Department of Specialist Pediatrics, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (S.C.); (M.D.); (B.M.G.); (C.D.-V.)
| | - Carlo Dionisi-Vici
- Laboratory of Metabolic Biochemistry Unit, Department of Specialist Pediatrics, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (S.C.); (M.D.); (B.M.G.); (C.D.-V.)
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.S.); (A.D.)
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.S.); (A.D.)
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Is gentamicin administered to individual patients in optimal doses already at the beginning of therapy? EUROPEAN PHARMACEUTICAL JOURNAL 2019. [DOI: 10.2478/afpuc-2019-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction A gentamicin dose, which the physicians select, frequently does not take any pharmacokinetic parameters into consideration.
Aim To analyse the results of therapeutic drug monitoring (TDM) of gentamicin for those patients who have not had the gentamicin dose adjusted at the beginning of therapy (first group) and for those patients who had the gentamicin dose adjusted at the beginning of therapy (second group).
Methods We acquired the basic data about patients from the requests for laboratory examination of levels of gentamicin. We measured all the gentamicin concentrations mentioned in this work using the FPIA method.
Results The monitored set included 379 hospitalized patients during a 4-year period. We divided the monitored set into 2 groups. First group was composed of patients without dose adjustment of gentamicin at the beginning of therapy, and the second group was composed of patients with dose adjustment of gentamicin by the clinical pharmacist at the beginning of therapy. In addition, the patients in each group were divided according to the body mass index (BMI). In the first group of patients, a low percentage of patients had both optimal levels (trough, peak levels). As for patients with BMI > 25 m2/kg, there were only 17 % such cases, and the patients with BMI ≤ 25 m2/kg were only 18.8 %. In the second group, the patients had all trough and peak levels in optimal therapeutic range at obese patients, overweight patients and also at patients with normal weight (p < 0.001).
Conclusion Adjustment of dosage regimens immediately at the beginning of therapy will provide for administering sufficient doses of antibiotics at the beginning of therapy, which is a pre-condition for a successful anti-infective therapy. Therapeutic monitoring of levels allows for administration of sufficient dose of gentamicin without fear of any undesirable effects.
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Rittmann B, Stevens MP. Clinical Decision Support Systems and Their Role in Antibiotic Stewardship: a Systematic Review. Curr Infect Dis Rep 2019; 21:29. [PMID: 31342180 DOI: 10.1007/s11908-019-0683-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to perform a systematic review over the past 5 years on the role and effectiveness of clinical decision support systems (CDSSs) on antibiotic stewardship. RECENT FINDINGS CDDS interventions found a significant impact on multiple outcomes relevant to antibiotic stewardship. There are various types of CDSS implementations, both active and passive (provider initiated). Passive interventions were associated with more significant outcomes; however, both interventions appeared effective. In the reviewed literature, CDSSs were consistently associated with decreasing antibiotic consumption and narrowing the spectrum of antibiotic usage. Generally, guideline adherence was improved with CDSS, although this was not universal. The effect on other outcomes, such as mortality, Clostridiodes difficile infections, length of stay, and cost, inconsistently showed a significant difference. Overall, CDDS implementation has effectively decreased antibiotic consumption and improved guideline adherence across the various types of CDSS. Other positive outcomes were noted in certain settings, but were not universal. When creating a new intervention, it is important to identify the optimal structure and deployment of a CDSS for a specific setting.
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Affiliation(s)
- Barry Rittmann
- Virginia Commonwealth University Health Systems, Richmond, USA. .,, 825 Fairfax Avenue, 4th Floor, Norfolk, VA, 23507, USA.
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A clinical decision support system to improve adequate dosing of gentamicin and vancomycin. Int J Med Inform 2019; 124:1-5. [DOI: 10.1016/j.ijmedinf.2019.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/29/2018] [Accepted: 01/01/2019] [Indexed: 12/21/2022]
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Litz JE, Goedicke-Fritz S, Härtel C, Zemlin M, Simon A. Management of early- and late-onset sepsis: results from a survey in 80 German NICUs. Infection 2019; 47:557-564. [DOI: 10.1007/s15010-018-1263-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022]
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[Dosing regimens of antibiotics in neonates: Variations in clinical practice and what should be done?]. Arch Pediatr 2016; 23:966-73. [PMID: 27451383 DOI: 10.1016/j.arcped.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 03/31/2016] [Accepted: 06/03/2016] [Indexed: 01/04/2023]
Abstract
There is wide variation in neonatal dosages of antibiotics in clinical practice, both nationally and internationally. This reflects the lack of evaluation of drugs in this therapeutic class, although widely prescribed. Given this situation, optimization of antibiotic prescription is required to ensure efficacy and safety of neonatal treatment and reduce microbial resistance. Rational prescription should be based on the knowledge of developmental pharmacokinetics and pharmacodynamics. Rigorous studies, conducted in collaboration between neonatologists and pharmacologists, are essential to develop and validate evidence-based neonatal dosage regimens.
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Abstract
Therapeutic drug monitoring (TDM) aims to integrate drug measurement results into clinical decision making. The basic rules apply when using TDM in neonates (aminoglycosides, vancomycin, phenobarbital, digoxin), but additional factors should also be taken into account. First, due to both pharmacokinetic variability and non-pharmacokinetic factors, the correlation between dosage and concentration is poor in neonates, but can be overcome with the use of more complex, validated dosing regimens. Second, the time to reach steady state is prolonged, especially when no loading dose is used. Consequently, the timing of TDM sampling is important in this population. Third, the target concentration may be uncertain (vancomycin) or depend on specific factors (phenobarbital during whole body cooling). Finally, because of differences in matrix composition (eg, protein, bilirubin), assay-related inaccuracies may be different in neonates. We anticipate that complex validated dosing regimens, with subsequent TDM sampling and Bayesian forecasting, are the next step in tailoring pharmacotherapy to individual neonates.
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Affiliation(s)
- Steven Pauwels
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
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