Pharmacokinetics of Gentamicin in Neonatal Patients Supported with Extracorporeal Membrane Oxygenation

Munzenberger, Paul J.; Massoud, Neil

doi:10.1097/00002480-199101000-00006

Cited by 26 publications

(15 citation statements)

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“…Unfortunately, PK data in adult patients on ECMO are sparse. Neonatal and animal studies are available but have shown significant variability and unpredictability of antibiotic PK during ECMO [32,35,46,50,[66][67][68][69][70][71][72][73][74][75][76][77][78][79] (Table 1). However, no dosing guidelines exist for this group of patients.…”

Section: Antibioticsmentioning

confidence: 99%

“…The standard cefotaxime dose regimen (50 mg/ kg of body weight twice a day [postnatal age, or PNA], b1 week), 50 mg/kg 3 times a day (PNA, 1-4 weeks), or 37.5 mg/kg 4 times a day (PNA, N4 weeks) provided sufficiently long periods of supra-minimum inhibitory concentration to provide adequate treatment of infants on ECMO. Neonatal PK studies of gentamicin have demonstrated an increase in the Vd for gentamicin (0.43-0.66 L/kg), a lower CL (41.0-101.4 mL kg −1 h −1 ), and a prolonged elimination half-life (5.2-12.9 hours) [32,35,46,[66][67][68][69]. Clinically, it is recommended to monitor gentamicin levels and extend the dosing intervals where necessary for patients on ECMO.…”

Section: Antibioticsmentioning

confidence: 99%

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Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

Shekar

Fraser

Smith

et al. 2012

Journal of Critical Care

287

315

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Section: Antibioticsmentioning

confidence: 99%

Section: Antibioticsmentioning

confidence: 99%

Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

Shekar

Fraser

Smith

et al. 2012

Journal of Critical Care

287

315

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“…However, the data suggest that the ECMO circuit can substantially alter the PK of antimicrobials resulting in changes to elimination and volume of distribution [155][156][157][158][159][160][161][162][163]. In addition, the critical condition of the patients in need of ECMO and the number of days on ECMO may further impact the PK changes observed.…”

Section: Triazoles and Extracoporeal Membrane Oxygenationmentioning

confidence: 99%

Triazole Use in the Nursery: Fluconazole, Voriconazole, Posaconazole, and Ravuconazole

Watt¹,

Manzoni²,

Cohen‐Wolkowiez³

et al. 2013

Current Drug Metabolism

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Invasive fungal infections in infants admitted to the neonatal intensive care unit are common and often fatal. The mainstay of therapy against invasive fungal infections is antifungal agents. Over the last two decades, the development and approval of these drugs evolved tremendously, and the azole class emerged as important agents in the treatment and prevention of invasive fungal infections. Among the azoles, fluconazole has been used extensively due to its favorable pharmacokinetics, excellent activity against Candida spp, and safety profile. This drug has been well studied in children but data for its use in infants are largely limited to Candida prophylaxis studies. Voriconazole, a second generation triazole, has excellent activity against Candida and Aspergillus spp. However, data on its use in neonates are extremely limited. Posaconazole and Ravuconazole are the newest agents of the triazole family. The antimicrobial spectrum of posaconazole is similar to voriconazole, but with additional activity against zygomycetes. Experience with posaconazole in children is very limited, and there are no reports of its use in infants. Ravuconazole is not approved for use by the FDA but studies in animals and humans show that it is often fungicidal and has favorable pharmacokinetics. In conclusion, the management of invasive fungal infections has progressed greatly over the last two decades with the azole antifungals playing a significant role. Related to this class, future research is needed in order to better assess dosing, safety, schedules and areas of use of these agents in infants admitted to the neonatal intensive care unit.

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“…Most available studies have demonstrated altered pharmacokinetics with changes in volume of distribution as well as clearance [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. These studies have been summarized in a review article in 2003 [23].…”

Section: Pharmacokinetic Studies In Neonatal and Pe-diatric Ecmomentioning

confidence: 99%

Pharmacotherapy in Neonatal and Pediatric Extracorporeal Membrane Oxygenation (ECMO)

Wildschut

Ahsman²,

Houmes³

et al. 2012

CDM

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ECMO support is an established life saving therapy for potentially reversible respiratory and/or cardiac failure. Improvement of outcome depends on effective treatment of the primary diagnosis and complications. Adequate drug therapy is important in reaching these goals. Pharmacokinetic and pharmacodynamic data in neonates and older children on ECMO are sparse. Most studies show altered volume of distribution and clearance for the drugs studied. This article gives an overview of the available PK and PD studies in neonates and children on ECMO, suggests possible mechanisms of altered PK and PD and identifies areas of interest for further research.

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Pharmacokinetics of Gentamicin in Neonatal Patients Supported with Extracorporeal Membrane Oxygenation

Cited by 26 publications

References 0 publications

Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

Triazole Use in the Nursery: Fluconazole, Voriconazole, Posaconazole, and Ravuconazole

Pharmacotherapy in Neonatal and Pediatric Extracorporeal Membrane Oxygenation (ECMO)

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