Optimizing Gentamicin Dosing in Pediatrics Using Monte Carlo Simulations

by Abdullah Alsultan, PhD; Manal Abouelkheir, PharmD; Yasmine Elsharawy, PharmD; Aljawharah Alkoraishi, BPharm; Reem Osman, PharmD; Michael N. Neely, MD; Wael Mansy, MD; Saeed Algahtani, PhD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002120

 

 

Gentamicin is known to have concentration-dependent bactericidal activity, and its nephrotoxic effect is well described. Researchers developed a population pharmacokinetic/pharmacodynamic model to optimize gentamicin dosing in pediatrics. Data were retrospectively collected for pediatric patients 1 month to 12 years of age, admitted to general pediatric wards or intensive care units and received gentamicin for suspected or proven Gram-negative infections at King Saud University Medical City, Riyadh, Saudi Arabia. A total of 306 gentamicin peak and trough concentrations sets from 107 patients were analyzed with mean (±standard deviation) patient age and weight of 4.5 ± 3.5 years and 16.7 ± 10.8 kg, respectively. Gentamicin pharmacokinetics were adequately described with a one compartment system (R 2 = 0.82, bias = 1.75% and precision = 88% for population predictions and R 2 = 0.94, bias = 5% and precision = 29% for individual predictions). The gentamicin pharmacokinetic parameters were as follows: volume of distribution = 8.9 L, total body clearance = 2.8 L/h for a 20-kg patient. Monte Carlo simulations showed that doses of 5–6 mg/kg/dose once daily are adequate only to treat infections with Gram-negative organisms having minimal inhibitory concentration less than 1 µg/mL. While, at minimal inhibitory concentration of 1 µg/mL, higher doses (7–8 mg/kg/dose once daily) are needed to maximize the efficacy of gentamicin. However, at minimal inhibitory concentration of 2 µg/mL, even a 10 mg/kg dose showed poor target attainment (52%). The finding of this study highlights the need to reevaluate the current breakpoints of gentamicin and also to assess the safety of higher doses of gentamicin in pediatrics.

Continue reading
5 Hits
0 Comments

New antibiotics for community-acquired pneumonia

by Marin H. Kollef and Kevin D. Betthauser

Published in Current Opinion in Infectious Diseases, scheduled for release April 2019. doi: 10.1097/QCO.0000000000000526

 

 

This review provides the rationale for the development of new antibiotics to treat community-acquired pneumonia (CAP). It also provides an overview of the new antibiotics targeting CAP that have recently received approval by the regulatory agencies, and those antibiotics that are in the development pipeline.

Continue reading
15 Hits
0 Comments

Paediatric use of antibiotics in children with community acquired pneumonia: A survey from Da Nang, Vietnam

by PT Nguyen, HT Tran, HT Truong, VT Nguyen, SM Graham, and BJ Marais

Published in The Journal of Paediatrics and Child Health, 17 February 2019. doi: 10.1111/jpc.14413

 

 

Researchers aimed to characterise paediatricians' antibiotic-prescribing behaviour when managing community acquired pneumonia.

Continue reading
13 Hits
0 Comments

Antibiotic Overuse in Premature Low Birth Weight Infants in a Developing Country

by Maria S. Rueda, MD; Renzo Calderon-Anyosa, MD; Jorge Gonzales, MD; Christie G. Turin, MD; Alonso Zea-Vera, MD; Jaime Zegarra, MD; Sicilia Bellomo, MD; Luis Cam, MD; Anne Castaneda, MD; and Theresa J. Ochoa, MD, on behalf of the NEOLACTO Research Group

To be published in The Pediatric Infectious Disease Journal, March 2019. doi: 10.1097/INF.0000000000002055

 

Neonatal sepsis is a leading cause of child morbidity and mortality, especially in premature and low birth weight infants. Prompt antibiotic therapy is warranted, but its inappropriate use leads to bacterial resistance and adverse outcomes. This study aims to describe the antibiotic use for late-onset sepsis in Peruvian premature infants.

 

Continue reading
26 Hits
0 Comments

Inappropriate Antibiotic Prescribing for Acute Bronchitis in Children and Impact on Subsequent Episodes of Care and Treatment

by Jake R. Morgan, PhD; Kathleen M. Carey, PhD; Tamar F. Barlam, MD; Cindy L. Christiansen, PhD; and  Mari-Lynn Drainoni, PhD 

To be published in The Pediatric Infectious Disease Journal, March 2019. doi: 10.1097/INF.0000000000002117

 

 

This study aimed to examine whether inappropriate antibiotic treatment for an initial bout of acute bronchitis in childhood affects patterns of future healthcare utilization and antibiotic prescribing.

Continue reading
25 Hits
0 Comments