Jump to content

JOIN THE DISCUSSION!

Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org

Leaderboard

Popular Content

Showing content with the highest reputation since 10/21/2013 in Tutorials

  1. Dose & administration Three doses at 24-hour intervals, as intravenous injections over 15 minutes, or by oro-gastric administration: 1st dose: 10 mg/kg 2nd and 3rd dose: 5 mg/kg Indications Closure of the patent ductus arteriosus. Contraindications and special considerations (incl incompatibilities) Contraindications include: duct-dependent cardiovascular malformation active bleeding, including intracranial, gastrointestinal or lung bleeding necrotizing enterocolitis (confirmed or suspected) significant thrombocytopenia or coagulation defects significantly reduced renal function significant hyperbilirubinemia Pulmonary hypertension has been reported when ibuprofen was given within 6 hours after birth. Concomitant use the following pharmaceuticals products is not recommended: diuretics: ibuprofen may reduce the effect of diuretics, and diuretics may increase the risk of renal insufficiency in dehydrated patients. anticoagulants: ibuprofen may inhibit platelet function and concomitant use with anticoagulants may increase the risk of bleeding corticosteroids: concomitant use with ibuprofen may increase the risk of gastrointestinal bleeding nitric oxide: since both nitric oxide and ibuprofen inhibit platelet function, concomitant use may in theory increase the risk of bleeding other NSAIDs: concomitant use of more than one NSAID should be avoided because of the increased risk of adverse reactions aminoglycosides: ibuprofen may reduce clearance of aminoglycosides, concomitant use may increase the risk of nephrotoxicity and ototoxicity, and surveillance of serum levels of aminoglycides should be performed Ibuprofen should not be administrated with any acidic solution. Adverse effects Oligura and transient renal insufficiency. Ibuprofen has less renal side-effects than indomethacin. Pharmacological aspects Ibuprofen is an anti-inflammatory drug (NSAID) that reduces the synthesis of prostaglandins through a non-selective inhibition of cyclo-oxygenase. Prostaglandins are involved in the persistence of the ductus arteriosus after birth, through relaxation of the muscle layer of the ductus arteriosus. The reduction of prostaglandins by ibuprofen is believed to be the main mechanism of action. The estimated T1/2 is 30 (16-43) hours. References Summary of product characteristics. Pedea -EMEA/H/C/000549 -IG/392. (URL) Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD003481. 
PMID: 25692606 Pulmonary hypertension after ibuprofen prophylaxis in very preterm infants. Lancet 2002; 359: 1486–88. PMID: 11988250 Document version history 2017-02-10 / Stefan Johansson
    4 points
  2. Dose & administration Initial dose: 0.05 to 0.1 microgram/kg/min via continuous IV infusion. Titrate to response, then decrease rate to provide the lowest dose while maintaining effect. Maximum dose: 0.4 microgram/kg/min. Higher initial infusion rates do not produce greater effects and are associated with more adverse effects Indications To maintain patency of the ductus arteriosus in congenital heart diseases dependent on shunting for oxygenation Contraindications and special considerations (incl incompatibilities) There are no known contraindications or incompatibilities. Adverse effects Apnea is experienced by 10-12% of infants with congenital heart defects treated with alprostadil, especially those weighing <2 kg at birth. Apnea usually occurs during the first hour of infusion. Respiratory status should be monitored during treatment. Staff trained in resuscitation and intubation should be available. Other common side-effects: fever, seizures, flushing, bradycardia, hypotension, tachycardia, leukocytosis, diarrhea, hypokalemia Uncommon side-effects (<1%): respiratory distress, wheezing, hyperbilirubinemia, anemia, bleeding, thrombocytopenia, hematuria Pharmacological aspects Alprostadil, or prostaglandin E1, causes vasodilation, inhibits platelet aggregation, and stimulates intestinal and uterine smooth muscle. As much as 80% may be metabolized in the first pass of the lungs. Metabolites are excreted via the kidneys within 24 hours. The half-life is <1 minute, thus necessitating a continuous infusion. References Arav-Boger R, Baggett HC, Spevak PJ, Willoughby RE: Leukocytosis caused by prostaglandin E1 in neonates. J Pediatr 2001;138:263-265. PMID 11174627 Browning Carmo KA, Barr P, West M, et al: Transporting Newborn Infants With Suspected Duct Dependent Congenital Heart Disease on Low-Dose Prostaglandin E1 Without Routine Mechanical Ventilation. Arch Dis Child Fetal Neonatal Ed 2007;92(2):F117-9. PMID 16905574 Cawello W, Schweer H, Muller R, et al: Metabolism and pharmacokinetics of prostaglandin E1 administered by intravenous infusion in human subjects. Eur J Clin Pharmacol 1994;46:275-7. PMID 8070511 Prostin VR Pediatric [package insert]. New York, NY: Pharmacia and Upjohn Company; 2013. Talosi G, Katona M, Turi S: Side-effects of long-term prostaglandin E1 treatment in neonates. Pediatr Int 2007;49:335-340. PMID 17532831 Document version history Created 2016-11-10 / Maegan Wells
    4 points
  3. Dose & administration Closure of Ductus Arteriosus: Dose is dependent on age of infant at time of therapy and course includes three doses given IV with 12 to 24 hour intervals between doses (ref 1). Post-natal age at first dose: Less than 48 hours: 1st dose 0.2 mg/kg, followed by 2nd and 3rd doses of 0.1 mg/kg/dose 2-7 days: 0.2 mg/kg/dose >7 days: 1st dose: 0.2 mg/kg, followed by 2nd and 3rd doses of 0.25 mg/kg/dose If the ductus arteriosus closes or is significantly reduced in size after an interval of 48 hours or more from completion of the first course, no further doses are necessary. If the ductus arteriosus re-opens, a second course of 1 to 3 doses may be given, each dose separated by a 12 to 24 hour interval as described above. Prevention of intraventricular hemorrhage: Although dosing regimes of 0.1-0.2 mg/kg/dose have been studied, the largest RCT (ref 2) used the following schedule: 0.1mg/kg/dose IV over 20 minutes and every 24 hours, beginning the first day of life and for a total of 3 doses. Indications To close a hemodynamically significant patent ductus arteriosus in preterm infants. To prevent intraventricular hemorrhage in preterm infants, weighing less than 1250g. Contraindications and special considerations (incl incompatibilities) Contraindications include active bleeding, significant thrombocytopenia or coagulation defects, necrotizing enterocolitis, untreated proven or suspected infection, and significantly impaired renal function. Incompatibilities: Solution: 7.5% dextrose in water and 10% dextrose in water Injection site: calcium gluconate, cimetidine, dobutamine, dopamine, gentamicin, and tobramycin Adverse effects Bleeding problems, higher incidence of transient oliguria and elevations of serum creatinine, decreased platelet aggregation, and hypoglycemia. Further, gastrointestinal perforations may occur if used concurrently with corticosteroids. For this reason, concomitant administration of indomethacin and glucocorticoids should be avoided. If anuria or marked oliguria (urinary output <0.6 mL/kg/hr) is evident at the scheduled time of the second or third dose of, do not give additional doses until laboratory studies indicate that renal function has returned to normal. Pharmacological aspects The exact mechanism of action through which indomethacin causes closure of a patent ductus arteriosus is not known, but inhibition of prostaglandin synthesis is the suggested mechanism of action. The plasma half-life of indomethacin is variable among premature infants and has shown to vary inversely with postnatal age and weight: Postnatal age less than 7 days old averaged 20 hours Postnatal age more than 7 days old averaged 12 hours Weighing less than 1000 g averaged 21 hours Weighing more than 1000 g averaged 15 hours Monitor urine output, serum electrolytes, glucose, creatinine and blood urea nitrogen levels, platelet counts, and signs of bleeding should be monitored during treatment. References Product Information: indomethacin IV injection. APP Pharmaceuticals, LLC (per Manufacturer), Schaumburg, IL, Mar, 2010. (URL) Long-Term Effects of Indomethacin Prophylaxis in Extremely-Low-Birth-Weight Infants. N Engl J Med 2001; 344:1966-1972. PMID: 11430325 Indomethacin Prophylaxis to Prevent Intraventricular Hemorrhage: Association between Incidence and Timing of Drug Administration. The Journal of pediatrics. 2013;163(3):706-10.e1. PMID: 23522865 Effects of Indomethacin Prophylaxis Timing on IVH and PDA in Extremely Low Birth Weight (ELBW) Infants. Archives of disease in childhood Fetal and neonatal edition. 2016;101(5):F418-F422. PMID: 18661761 Managing the patent ductus arteriosus in the premature neonate: a new look at what we thought we knew. Semin Perinatol Apr, 2012; 36(2): 130-138. PMID: 22414884 Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2010, Issue 7. Art. No.: CD000174. PMID: 20614421
    3 points
  4. Dose & administration Lidocaine should be administered intravenously and can be diluted in dextrose and normal saline solutions. Dose per kg varies according to the duration after the first maintenance dose, and depends on the body temperature when administered: Loading dose – 2 mg/kg over 10 minutes Maintenance dose for normothermic infants: The loading dose is followed by 6 mg/kg/hour over 4 hours, 4 mg/kg/hour over 12 hours, and 2 mg/kg/hour over 12 hours. Hypothermic infants: The loading dose is followed by 7 mg/kg/hour over 3.5 hours, 3.5 mg/kg/hour over 12 hours, and 1.75 mg/kg/hour over 12 hours. Indications Refractory seizures despite first-line treatments in term infants > 2.5kg. Contraindications and special considerations (including incompatibilities) Lidocaine is contraindicated in complete AV block III and wide QRS complex tachycardia. Further, risk factors for cardiotoxicity are unstable potassium serum levels, (congenital) cardiac dysfunction and concurrent phenytoin use. Should not be used with phenytoin. Compatible at terminal injection site with aminophylline, ampicillin, caffeine citrate, calcium (chloride and gluconate), dexamethasone, digoxin, dobutamine, dopamine, fentanyl, heparin, hydrocortisone, insulin, micafungin, morphine, penicillin G, potassium chloride, and sodium bicarbonate. Adverse effects Arrhytmias (rare). Pharmacological aspects Mechanism of action uncertain, probably acts as a membrane stabilizer. Metabolized in liver into its active metabolites and excreted in urine. Tends to accumulate in tissues with high blood flow and to redistribute later. T½ 200 minutes. Use should not be longer than the recommended schedule above. References Anticonvulsant treatment of asphyxiated newborns under hypothermia with lidocaine: efficacy, safety and dosing. Arch Dis Child - Fetal Neonatal Ed. 2013;98(4):F341–F345. PMID 23303304 Weeke LC, Toet MC, van Rooij LGM, et al. Lidocaine response rate in aEEG-confirmed neonatal seizures: Retrospective study of 413 full-term and preterm infants. Epilepsia. 2016;57(2):233–242. PMID 26719344 Weeke LC, Schalkwijk S, Toet MC, van Rooij LGM, de Vries LS, van den Broek MPH. Lidocaine-Associated Cardiac Events in Newborns with Seizures: Incidence, Symptoms and Contributing Factors. Neonatology. 2015;108(2):130–136. PMID 26111505 Lundqvist M, Ågren J, Hellström-Westas L, Flink R, Wickström R. Efficacy and safety of lidocaine for treatment of neonatal seizures. Acta Paediatr. 2013;102(9):863–867. PMID 23738612 Slaughter LA, Patel AD, Slaughter JL. Pharmacological treatment of neonatal seizures: a systematic review. J Child Neurol. 2013;28(3):351–364. PMID 23318696 Document version history Created 2016-10-03 / André M. Graça
    2 points
  5. Dose & administration Loading dose 20 mg/kg of caffeine citrate (corresponding to 10 mg/kg of caffeine base), intravenously over 30 minutes. Maintenance dose 5-10 mg/kg once daily, intravenously over 10 minutes or by oral administration, 24 h after the loading dose. A higher maintenance dose can be considered but the possibility of accumulation should be taken into account. Can be discontinued when the infant has been free from significant apneas 5-7 days. Can be diluted in sterile solutions for infusion with glucose 50 mg/ml or sodium chloride 9 mg/ml. Indications Apnea of prematurity. BPD prevention. Contraindications and special considerations Apnea of prematurity is a diagnosis of exclusion. Always consider other possible causes of instable breathing. Caffeine stimulates the CNS and the cardiovascular system, and should be used cautiously in infants with seizure disorders and congenital heart defects. Caffeine increase metabolism which may result in higher energy and nutrition requirements during therapy. Measurement of plasma levels of caffeine is possible. A range of 8-30 mg/l has been associated with clinical benefit and levels above 50 mg/l could be regarded as elevated. Adverse effects Infusion site phlebitis Hyperglycemia Exacerbation of gastro-esophageal reflux Tachycardia/arrhythmias Convulsions Pharmacological aspects Caffeine acts by antagonism of adenosine receptors and act as a CNS stimulant. Several mechanisms have been proposed for its effect on apnea of prematurity, such as respiratory center stimulation, increased minute ventilation, decreased threshold to hypercapnia, and increased response to hypercapnia. Onset of action is within minutes after intravenous infusion and after oral administration the peak concentration is reached in 30-120 minutes. Elimination is predominantly by renal clearance and to some extent by hepatic clearance (Cytochrome P450 1A2). Mean half-life (T1/2) are inversely related to gestational / postmenstrual age. In newborn infants, the T1/2 is approximately 3-4 days but increases over time. By 9 months of age, caffeine metabolism approximates that of adults (T1/2 = 5 hours). The pharmacokinetics in newborn infants with hepatic or renal insufficiency have not been studied. Infants with significant renal impairment may risk accumulation. Cholestasis may also prolong half-life. References European Medicines Agency. European public assessment report (EPAR) for Peyona. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/001014/human_med_000940.jsp Schmidt. Caffeine Therapy for Apnea of Prematurity. N Engl J Med 2006;354:2112-21. PMID 16707748. Schmidt. Long-Term Effects of Caffeine Therapy for Apnea of Prematurity. N Engl J Med 2007;357:1893-1902. PMID 17989382. Eichenwald. Apnea of prematurity. Pediatrics 2016:e20153757. PMID 26628729. Document version history Created 2016-05-15 / Stefan Johansson
    2 points
  6. Dose & administration Prevention of iron deficiency: Preterm infants: 2-4 mg/kg/day of elemental iron in divided oral doses; initiate no later than 1 month of age and continued through at least 1 year of age, depending on nutritional context and other iron intake. Maximum of 15 mg/day. Term infants: 1 mg/kg/day of elemental iron orally; may not need to initiate until 4 months of age. Low birth weight infants (<2500 g): 2-3 mg/kg/day of elemental iron in divided oral doses during the first 6 months of life. Treatment of iron deficiency: 4-6 mg/kg/day of elemental iron in divided oral doses until serum markers of iron deficiency have normalized. Supplement during epoetin administration: 6 mg/kg/day of elemental iron in divided oral doses. Indications Prevention of iron deficiency. Treatment of iron deficiency. Contraindications and special considerations (incl incompatibilities) Oral products are available in many formulations- verify concentration and dose before use. Consider monitoring iron storage via serum ferritin levels, especially in infants who have received many blood transfusions. If the ferritin level is >350 microgram/L, halt iron supplementation until the level has decreased to <350 microgram/L. Hypersensitivity to iron or any component of the formulation. Hemolytic anemia. Adverse effects Common side effects include nausea, vomiting, constipation, upset stomach, and black stools. Iron toxicity may include an increase in free radical formation, thus increasing oxidative stress. Pharmacological aspects Iron is an essential part of the heme groups forming hemoglobin, the oxygen-binding metalloprotein of red blood cells. Onset of action for oral administration is about 5-10 days. Effects on hemoglobin may be seen in 2-4 weeks. Enteral absorption is about 30%. Iron is not actively excreted in the stool or urine, so virtually all absorbed iron remains in the body. References Baker RD, Greer FR, and Committee on Nutrition American Academy of Pediatrics, "Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age)," Pediatrics, 2010, 126(5):1040-50. PMID 20923825. Berglund S, Domellof M, “Meeting iron needs for infants and children,” Curr Opin Clin Nutr Metab Care, 2014, 17(3):267-72. PMID: 24535217. Meyer MP, Haworth C, Meyer JH, et al, "A Comparison of Oral and Intravenous Iron Supplementation in Preterm Infants Receiving Recombinant Erythropoietin," J Pediatr, 1996, 129(2):258-63. PMID 8765624. Rao R and Georgieff MK, "Iron Therapy for Preterm Infants," Clin Perinatol, 2009, 36(1):27-42. PMID 19161863. United Nations Children's Fund, United Nations University, World Health Organization. Iron deficiency anaemia assessment, prevention, and control. A guide for programme managers, 2001. Available from: http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf?ua=1 Document version history Created 2017-01-14 / Maegan Wells
    2 points
  7. Dose & administration There are different schools of thought regarding gentamicin dosing in neonates and tertiary dosing references vary in their dosing recommendations. Commonly accepted dosing regimens include both a gestational age based dosing approach as well as birth-weight based dosing approach. Doses range from 4-5mg/kg per dose administered every 24 to 48 hours with lower gestational ages requiring the higher weight based dosing and longer dosing interval than older gestational age infants. The NICE guidelines (UK) recommend 5 mg/kg every 36 hours as the starting dose. The dose and interval should be guided by measurements of blood gentamicin concentrations, typically immediately before the second dose and before later doses if the serum concentration is high. The recommended concentration is < 2 mg/L. Indications Widely used in the NICU in combination with a beta lactam or other antibiotic as empiric therapy in both early onset and late onset sepsis. Contraindications and special considerations (including incompatibilities) Caution should be used in infants with decreased renal function or history that might suggest poor renal perfusion such as asphyxiation, indomethacin exposure, PDA, etc. May interact with neuromuscular blockers. Additional monitoring of gentamicin levels may be required during ECMO and/or therapeutic hypothermia as either may affect gentamicin pharmacokinetics. Target peaks of 8-12 mcg/mL; target troughs < 1 to minimize toxicity. Due to incompatibility, gentamicin should not be administered in the same line with ampicillin, indomethacin, amphotericin B, and furosemide. Adverse effects Nephrotoxicity Ototoxicity May enhance neuromuscular blockade when administered concomitantly with neuromuscular blockers Pharmacological aspects Gentamicin, like other aminoglycosides, exhibits its action by inhibiting protein synthesis by irreversibly binding to ribosomal RNA of the microorganism. Gentamicin is active against Gram-negative bacteria including Pseudomonas aeruginosa. It may be used with other agents for synergy against Gram-positive organisms, but should not be used alone to treat these infections. Aminoglycosides are concentration dependent antibiotics. They work best when the serum concentration of the drug reaches very high concentrations. Conversely, they also possess a unique property known as post-antibiotic effect where bacterial killing continues to occur when the drug is no longer present in appreciable amounts in the bloodstream. References Neonatal infection: antibiotics for prevention and treatment. NICE guidelines [CG149]. 2012. https://www.nice.org.uk/guidance/CG149/ Effect of hypothermia and extracorporeal life support on drug disposition in neonates. Seminars in Fetal & Neonatal Medicine. 2013; 18(1): 23-27. PMID 23158109. Dose optimisation of antibiotics in children: application of pharmacokinetics/ pharmacodynamics in paediatrics. Int J Antimicrob Agents. 2014 Mar;43(3):223-30. PMID: 24389079. Developmental pharmacokinetics of gentamicin in preterm and term neonates: population modelling of a prospective study. Clin Pharmacokinet. 2009 Jan;48(4):253-63. PMID: 19492870. Document version history Created 2016/06/22 / Amy Holmes
    2 points
  8. Dose & administration 2-20 mcg/kg/min administered via continuous intravenous infusion, and titrated to desired blood pressure effect. Different doses lead to different patterns of stimulation effects on dopaminergic, beta-1, and alpha receptors (see Pharmacological aspects) Administration of dopamine via large vein is preferred to prevent extravasation Can be administered through intravenous or intraosseous route Avoid bolus administration Dilute vials prior to administration per your local protocols Indications Hypotension: there is no standard definition for hypotension in term or preterm infants, and variations should take into consideration gestational age and postnatal age. Severe sepsis and septic shock: dopamine is indicated in full-term neonates that are non-responsive to fluid resuscitation Contraindications and special considerations (incl incompatibilities) Special considerations: use of a small vein may lead to extravasation, which should be treated with phentolamine (Phentolamine 0.5mg/ml; inject 1-5 mL into affected area) Stability: Once diluted, solution is stable for 24 hours (compatible in 5% dextrose in water, 5% dextrose in sodium chloride, 10% dextrose in water, lactated ringers, and 0.9% sodium chloride) Incompatibilities, injection site: acyclovir, alteplase, amphotericin B, ampicillin, cefepime, furosemide, indomethacin, insulin, penicillin G, sodium bicarbonate Adverse effects Tachycardia, arrhythmias, increased pulmonary artery pressure, suppression of prolactin secretion (reversible), potential for local necrosis or infiltration. Pharmacological aspects Mechanism of action: catecholamine that increases blood pressure by increasing systemic vascular resistance through α-adrenergic effects Dose-dependent effects: 0.5-2.0 mcg/kg/min: dopaminergic stimulation (vasodilation, increased renal blood flow, GFR, urinary output) 2-10 mcg/kg/min: beta-1 receptor stimulation (improved contractility, cardiac output, and impulse conduction) 10-20 mcg/kg/min: alpha-receptor stimulation (vasoconstriction and increased blood pressure) >20 mcg/kg/min: alpha-receptor stimulation overrides dopaminergic effects (reversal of renal vasodilation and natriuresis) Selective renal vasodilation with increased urine output in preterm neonates when dosed at 2-5 mcg/kg/minute Half-life: 2-5 minutes with varying clearance Monitoring: heart rate, blood pressure, urine output, peripheral perfusion, signs of infiltration Document version history Created 2017-08-23 / Amanda Teachey References Kleinman ME, Chameides L, Schexnayder SM et al. 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 14: pediatric advanced life support. Circulation Nov02, 2010; 122(18 Suppl.3): S876-S908. PMID 20956258 Seri I. Cardiovascular, renal, and endocrine actions of dopamine in neonates and children. J Pediatr 1995;126:333. PMID 7869189 Lynch SK, Lemley KV, Polak MJ. The effect of dopamine on glomerular filtration rate in normotensive, oliguric premature neonates. Pediatr Nephrol 2003;18:649-652. PMID 12750981 Product Information: dopamine hydrochloride injection, dopamine hydrochloride injection. American Regent Laboratories Inc, Shirley, NY, 04/00/2001. URL Institute for Safe Medication Practices (ISMP) and Vermont Oxford Network (VON). Standard concentrations of neonatal drug infusions. Institute for Safe Medication Practices (ISMP), Horsham, PA, May24, 2011. Available at: http://ismp.org/Tools/PediatricConcentrations.pdf Subhedar NV, Shaw NJ. Dopamine versus dobutamine for hypotensive preterm infants. Cochrane Database Syst Rev. 2003;(3):CD001242. PMID: 12917901 Bhatt-Mehta V, Nahata MC, McClead RE, et al. Dopamine pharmacokinetics in critically ill newborn infants. Eur J Clin Pharmacol (1991) 40:593. PMID 1884740 Bellomo R, Cole L, & Ronco C: Hemodynamic support and the role of dopamine. Kidney Int 1998; 53:S71-S74. PMID 9573578 Goldberg LI: Cardiovascular and renal actions of dopamine: potential clinical applications. Pharmacol Rev 1972; 24:1. PMID: 4554480
    1 point
  9. Dose & administration The dose depends on gestational age (GA) and postnatal age (PNA): ≤ 34 weeks GA and ≤ 7 days PNA: 50 mg/kg/dose, every 12 hours (q12h). ≤ 34 weeks GA and 8 - 28 days PNA: 75 mg/kg/dose, every 12 hours (q12h). ≥ 35 weeks GA and 0-28 days PNA: 50 mg/kg/dose, every 8 hours (q8h). In the case of meningitis or severe septicemia the doses may be increased twofold. Maximal dose: 400 mg/kg/day IV administration is preferable, as an IV push over 3-5 min. Intraosseous injection may be used if venous access is not available, but intramuscular injection is not recommended. Indications Early onset neonatal infection (sepsis), proved or strongly suspected caused by sensitive bacterias, such as Group B streptococcus, enterococcus, E coli,and Listeria monocytogenes. Contraindications and special considerations Hypersensitivity to penicillin derivatives is a contraindication. Dosage adjustment may be necessary in patients with renal impairment Known Y-site incompatibilities are amikacin, amiodarone, dopamine, epinephrine, erythromycin, fluconazole, gentamicin, hydralazine, metoclopramide, midazolam, nicardipine, sodium bicarbonate, tobramycin. Adverse effects Most common adverse events are: Oral or gluteal/perineal candidiasis Vomiting, diarrhea Hepatic impairment with long term use Hypersensitivity reaction - maculopapular rash, urticarial rash, hemolytic anemia, thrombocytopenia, pancytopenia or fever (hypersensitivity reactions are not commonly seen in the neonatal period, although one have to be aware about the possibility of anaphylaxis reaction) Pseudomembranous enterocolitis Some risk of convulsions exists if high serum concentration of ampicillin (>140mg/ml) is achieved Pharmacological aspects Ampicillin is a wide spectrum antibiotic, semi-synthetic penicillin with bactericidal action, acting by inhibiting synthesis of the bacterial cell wall . It may effective against a wide range of Gramm-positive and Gramm-negative bacteria, for example hemolytic and nonhemolytic streptococci, nonpenicillinase-producing staphylococci, Clostridium spp., Listeria monocytogenes, many strains of enterococci, H. influenzae, N. Gonorrhoeae, N. Meningitidis,and E. coli. Ampicillin is prone to destruction by penicillinasae activity and therefore is inefficient against penicillinasae producing bacteria. Furthermore, resistance to ampicillin may develop and an increasing numbers of Haemophilus influenza are becoming resistant. However, most of the bacteria causing early onset neonatal infection are sensitive still to ampicillin and/or its combination with gentamicin. Positive bacterial cultures should always be combined with antimicrobial sensitivity testing. Clearance is ensured predominantly by kidneys in infants with a gestational age >37 weeks. Half-life (T1/2) ranged from 2.2 to 3.9 h in term infants whereas in preterm infants T1/2 was 4.0 h. T1/2 decrease with increasing postnatal age. There is lack of data available relative to clearance and volume of distribution in neonates. Preparation Reconstitution with sterile water for injection is recommended. Maximum concentration for the IV infusion is 100 mg/ml. Reconstituted solution should be used within 1 hour. Solution compatibility: 5% glucose (loss of stability after 1 hour), Sodium chloride 0.95%, Mixture of 5% Glucose (Dextrose) and Sodium chloride 0.45%, Ringer’s Lactate solution Solution incompatibility: solutions for parenteral nutrition References Gian Maria Pacifici. Clinical Pharmacokinetics of Penicillins, Cephalosporins and Aminoglycosides in the Neonate: A Review. Pharmaceuticals (Basel). 2010 Aug; 3(8): 2568–2591; doi:10.3390/ph3082568; http://www.mdpi.com/1424-8247/3/8/2568/htm Leslie C. Pineda and Kevin M. Watt. New Antibiotic Dosing. Clin Perinatol. 2015 March ; 42(1): 167–176. doi:10.1016/j.clp.2014.10.009. PMID:25678003 Adriana Tremoulet, Jennifer Le, Brenda Poindexter, Janice E. Sullivan et al. Characterization of the Population Pharmacokinetics of Ampicillin in Neonates Using an Opportunistic Study Design. Antimicrobial Agents and Chemotherapy. 2014 Volume 58 Number 6p. 3013–3020 . URL http://aac.asm.org/content/58/6/3013.full?sid=48f1a07e-4438-48ac-8eb4-d4ee6836b7e1 J. Jacobs, Dina Kletter, E. Superstine et al. Intravenous infusions of heparin and penicillins. J Clin Pathol. 1973 Oct; 26(10): 742–746. PMID:4750455 Hanne Colding and Gunnar Eg Andersen. Stability of Antibiotics and Amino Acids in Two Synthetic Amino Acid Solutions Commonly Used for Total Parenteral Nutrition in Children. Antimicrobial Agents and Chemotherapy, Apr. 1978, p. 555-558 PMID:27137 R A Johnson. Adverse reactions in ten years' general practice, computer analysed. Journal of the Royal Society of Medicine Volume 79 March 1986, 145-148. PMID:3486291 P. Brodlie, C. Henney, A. J. J. Wood. Problems of Administering Drugs by Continuous Infusion. British Medical Journal 2 March 1974,383-385 PMID:4819177 E. D. Hodby, J. Hirsh, and C. Adeniyi-Jones. The influence of drugs upon the anticoagulant activity of heparin. Can Med Assoc J., v.106(5); 1972 Mar 4, 562-564. PMID:5027639 Document version history Created 2016-07-04 / Yuriy Korzhynskyy
    1 point
  10. Dose & administration Acyclovir is dosed 20mg/kg/dose IV at intervals depending on gestational age. Specifically, Sampson et al (PMID: 24346595) recommend dosing intervals to be 12 hours (q12h) in infants < 30 weeks PMA; 8 hours (q8h) in infants 30 to <36 weeks PMA; and 6 hours (q6h) in infants 36-41 weeks PMA. Administer over one hour in order to prevent adverse effects. For congenital HSV infections, treatment course depends on type of infection. SEM disease is treated for 14 days. Disseminated and CNS infections require a minimum of 21 days of therapy. Asymptomatic infants born to mothers with active genital lesions may require 10 days of treatment. Oral acyclovir may be used for suppressive therapy following completion of full IV course. This dose is 300mg/m2 PO three times daily. Indications Acyclovir is most commonly used in the neonatal population as treatment for congenital herpes simplex infections. It may also be used for chronic suppression of HSV or for treatment of herpes zoster infection. Contraindications and special considerations (incl incompatibilities) The risk of nephrotoxicity is increased when acyclovir is administered in conjunction with other nephrotoxic drugs. Acyclovir’s incompatibilities include: dopamine, dobutamine, epinephrine, fat emulsions, aztreonam, caffeine, caspofungin, cefepime, meropenem, piperacillin/tazobactam, and parenteral nutrition solutions. Adverse effects The most common adverse effects are neutropenia and renal dysfunction secondary to crystalluria. Ensuring adequate hydration during therapy can prevent crystalluria and subsequent renal dysfunction. Frequent monitoring of CBCs can detect neutropenia. With a pH of 10, acyclovir can cause phlebitis and may be very damaging to tissue if extravasation occurs. One might consider using a dedicated PICC-line for acyclovir administration. Pharmacological aspects Acyclovir works by inhibiting viral DNA synthesis. Its primary route of elimination is renal. Postmenstrual age has been determined to be the variable with the most significant influence on clearance of acyclovir. References Oral acyclovir suppression and neurodevelopment after neonatal herpes. NEJM. 2011;365:1284-92. PMID 21991950. Population pharmacokinetics of intravenous acyclovir in preterm and term infants. Pediatr Infect Dis J. 2014;33:42-9. PMID 24346595. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Pediatrics. 2013;131:e635-e646. PMID 23359576. The use of antiviral drugs during the neonatal period. Clin Perinatol. 2012;39:69-81. PMID 22341538. Document version history Created 2016/6/26 / Amy Holmes
    1 point
This leaderboard is set to Stockholm/GMT+02:00
×
×
  • Create New...