Aminoglycoside and vancomycin serum concentration monitoring and mortality due to neonatal sepsis in Saudi Arabia.
OBJECTIVE
To assess the effectiveness of monitoring of serum concentration of aminoglycosides in neonates.


METHODS
A retrospective evaluation of serum concentration monitoring of aminoglycosides (gentamicin and amikacin) and vancomycin in neonates treated for sepsis in a maternity and children hospital in Jeddah, Saudi Arabia, over the period 1998-2000.


RESULTS
The total number of requests for monitoring increased sixfold in 1999 and 12-fold in 2000 relative to 1998. For aminoglycosides, the incidence of both subtherapeutic peak and toxic trough serum levels decreased significantly (P < 0.05) in 1999 and 2000 compared with 1998. Furthermore, the rate of neonatal mortality caused by sepsis showed reduction in both 1999 (34%) and 2000 (35%) in comparison with 1998 (45%). Vancomycin trough (effective) concentration monitoring revealed no change in the incidence (30%) of levels at subtherapeutic values (<5.0 microg/mL) between the compared years. Furthermore, the rate of toxic levels (>10 microg/mL) increased in both 1999 (31%) and 2000 (39%) relative to 1998 (25%).


CONCLUSIONS
Therapeutic drug monitoring of vancomycin needs re-evaluation in the hospital to explain why existing methods are ineffective.
El Desoky
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ES
Pharmacology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. ehegypt@yahoo.com
Sheikh
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AA
Al Hammadi
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AY
D000583:Amikacin / Q000097:blood* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000627:therapeutic use; D005839:Gentamicins / Q000097:blood* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D012189:Retrospective Studies; D012529:Saudi Arabia; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D014640:Vancomycin / Q000097:blood* / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D000583:Amikacin