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    Evaluation of Neonate-Specific Gentamicin Dosing Protocols Using a Pooled Patient Data Set: A Retrospective Analysis

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    Author
    McCormick, Nate
    Stoffel, Shaun
    Affiliation
    College of Pharmacy, The University of Arizona
    Issue Date
    2005
    Keywords
    Neonates
    Gentamicin
    Dosing Protocols
    MeSH Subjects
    Neonates
    Gentamicins
    Advisor
    Murphy, John E.
    
    Metadata
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    Rights
    Copyright © is held by the author.
    Collection Information
    This item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Associate Librarian and Clinical Instructor, Pharmacy Practice and Science, jenmartin@email.arizona.edu.
    Publisher
    The University of Arizona.
    Abstract
    Objectives: First, to evaluate five recent gentamicin dosing protocols that are specific for neonates and determine how frequently each protocol yields desirable peak and trough concentrations. Second, to make our evaluation more robust, we included AUC as one of the pharmacokinetic parameters and compared it to traditional parameters. Finally, to evaluate a fixed dosing protocol (3 mg/kg Q24-hours) that is currently being used at one Arizona hospital (UMC). Methods: This retrospective evaluation involved datasets from three independent sources. Dataset 1 was from a previously published study, while datasets 2 and 3 were derived for this study. Datasets 1 and 2 were pooled to evaluate the five dosing protocols, while dataset 3 was used to evaluate the fixed dosing protocol used at UMC. For all subjects, demographic and laboratory data was obtained from hospital databases or charts. The data collected was used to construct pharmacokinetic values, which in turn were used in simulations with the five protocols. Dataset 3 was evaluated as a whole for frequency of desired peaks and troughs, then for subsets based on weight, gestational age, and Apgar scores. Results: Of the five evaluated, the Avent protocol yielded the fewest potentially toxic troughs. The Murphy-Carter protocol stood out in that it was the easiest to use, most universally applicable, and it yielded only slightly fewer desired troughs then the Avent protocol. AUC values proved to be a novel and exceptionally useful tool in evaluating the dosing protocols. The fixed dosing protocol used at UMC was shown to consistently produce favorable trough concentrations as a whole as well as in our subset analyses. Implications: The multitude of dosing protocols that have been offered can create confusion among health care professionals and lead to discrepancies in dosing. The primary goal of any of these protocols is to minimize the risk of toxicity while avoiding subtherapeutic doses. A dosing protocol that can consistently meet these criterion, yet offer simplicity and wide applicability, then we can come that much closer to a universal standard.
    Description
    Class of 2005 Abstract
    Collections
    Pharmacy Student Research Projects

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