Abstract
Once daily dosing of aminoglycosides has been introduced and validated in non-neonatal patient cohorts. This is because aminoglycosides display peak concentration dependent bacterial killing, have a postantibiotic effect and adaptive resistance. In addition, this strategy reduces toxicity. Although aminoglycosides are also frequently administered to neonates, there is still debate about how to integrate and extrapolate these extended interval dosing regimens into dosing schedules tailored for neonates. There is a growing body of knowledge on aminoglycoside disposition and its covariates (e.g. asphyxia, ibuprofen or indomethacin exposure, serum creatinine, sepsis, dose accuracy) in neonates. In essence, integration of developmental physiology with clinical pharmacology unveils a discrepancy between aspects related to either body composition (higher distribution volume necessitates higher dose, to attain peak concentration) or to elimination clearance (lower renal clearance necessitates prolonged time interval between administrations).
Such discrepancy can be solved by introducing more complex dosing guidelines (based on weight, postnatal age, serum creatinine, ibuprofen, asphyxia) in neonates. However, the introduction of more complex dosing guidelines should be balanced with its clinical feasibility. At least, there are reports that these more complex dosing guidelines result in a higher incidence of dosing errors. Besides errors in prescription, these errors also relate to the number of dilutions or manipulations needed before the prescribed dose can be administered. Since an integrated approach is needed, we discuss in this overview both the available pharmacokinetic data in support of the use of extended dosing regimens in neonates as well as the strategies suggested to reduce dosing errors.
Keywords: Pharmacodynamics, pharmacokinetics, newborn, aminoglycosides, renal function, extended interval dosing, safety, care bundle.
Current Pharmaceutical Design
Title:Dosing Guidelines of Aminoglycosides in Neonates: A Balance Between Physiology and Feasibility
Volume: 21 Issue: 39
Author(s): Karel Allegaert, Veerle Cossey and John N. van den Anker
Affiliation:
Keywords: Pharmacodynamics, pharmacokinetics, newborn, aminoglycosides, renal function, extended interval dosing, safety, care bundle.
Abstract: Once daily dosing of aminoglycosides has been introduced and validated in non-neonatal patient cohorts. This is because aminoglycosides display peak concentration dependent bacterial killing, have a postantibiotic effect and adaptive resistance. In addition, this strategy reduces toxicity. Although aminoglycosides are also frequently administered to neonates, there is still debate about how to integrate and extrapolate these extended interval dosing regimens into dosing schedules tailored for neonates. There is a growing body of knowledge on aminoglycoside disposition and its covariates (e.g. asphyxia, ibuprofen or indomethacin exposure, serum creatinine, sepsis, dose accuracy) in neonates. In essence, integration of developmental physiology with clinical pharmacology unveils a discrepancy between aspects related to either body composition (higher distribution volume necessitates higher dose, to attain peak concentration) or to elimination clearance (lower renal clearance necessitates prolonged time interval between administrations).
Such discrepancy can be solved by introducing more complex dosing guidelines (based on weight, postnatal age, serum creatinine, ibuprofen, asphyxia) in neonates. However, the introduction of more complex dosing guidelines should be balanced with its clinical feasibility. At least, there are reports that these more complex dosing guidelines result in a higher incidence of dosing errors. Besides errors in prescription, these errors also relate to the number of dilutions or manipulations needed before the prescribed dose can be administered. Since an integrated approach is needed, we discuss in this overview both the available pharmacokinetic data in support of the use of extended dosing regimens in neonates as well as the strategies suggested to reduce dosing errors.
Export Options
About this article
Cite this article as:
Allegaert Karel, Cossey Veerle and van den Anker N. John, Dosing Guidelines of Aminoglycosides in Neonates: A Balance Between Physiology and Feasibility, Current Pharmaceutical Design 2015; 21 (39) . https://dx.doi.org/10.2174/1381612821666150901110659
DOI https://dx.doi.org/10.2174/1381612821666150901110659 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Synthetic Glucocorticoids: Antenatal Administration and Long-term Implications
Current Pharmaceutical Design Progesterone: Indications for the Prevention of Preterm Birth
Current Women`s Health Reviews Role of Endothelin in Uteroplacental Circulation and Fetal Vascular Function
Current Vascular Pharmacology Pharmacokinetic Evaluation of Callistemon viminalis Derived Natural Compounds as Targeted Inhibitors Against δ -Opioid Receptor and Farnesyl Transferase
Letters in Drug Design & Discovery Pulmonary Vasodilators in the Management of Low Cardiac Output Syndrome After Pediatric Cardiac Surgery
Current Vascular Pharmacology Perinatal Heart Programming: Long-term Consequences
Current Medicinal Chemistry Steroids and Vasopressor-Resistant Hypotension in Preterm Infants
Current Pediatric Reviews Clinical Pharmacology of Ibuprofen and Indomethacin in Preterm Infants with Patent Ductus Arteriosus
Current Pediatric Reviews Heart Transplantation for Congenital Heart Disease in the First Year of Life
Current Cardiology Reviews Clinical Pharmacology of Non-Steroidal Anti-Inflammatory Drugs: A Review
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry Coarctation of the Aorta - An Evolution of Therapeutic Options
Current Cardiology Reviews A Review of Selected Adult Congenital Heart Diseases Encountered in Daily Practice
Current Cardiology Reviews Pulmonary Complications After Congenital Heart Surgery
Current Respiratory Medicine Reviews Is Propofol the Perfect Hypnotic Agent for Procedural Sedation in Neonates?
Current Clinical Pharmacology Near-Infrared Spectroscopy (NIRS): A Non-Invasive In Vivo Methodology for Analysis of Brain Vascular and Metabolic Activities in Real Time in Rodents
Current Vascular Pharmacology Free Radicals in Diseases and Potential Role of Phytoconstituents-A Cause with Emerging Importance
Current Chemical Biology Cytochrome P450 2C8 and Drug Metabolism
Current Topics in Medicinal Chemistry Cyclooxygenase-2 Biology
Current Pharmaceutical Design Serum Interleukin-33 as a Biomarker in Predicting Neonatal Sepsis in Premature Infants
Combinatorial Chemistry & High Throughput Screening Pediatric Heart Failure in the Developing World
Reviews on Recent Clinical Trials