학술논문
Once- Versus Twice-daily Gentamicin Dosing in Neonates [is greater than or equal to] 34 Weeks' Gestation: Cost-effectiveness Analyses
Document Type
Academic Journal
Author
Source
Pediatrics. March, 1999, Vol. 103 Issue 3, p594, 1 p.
Subject
Language
ISSN
0031-4005
Abstract
Once-daily gentamicin dosing may be superior to twice-daily dosing in newborns receiving the antibiotic for possible infections. Researchers treated 55 newborns for 72 hours with either once-a-day or twice-a-day gentamicin. Peak blood levels of the drug were higher in infants given once-daily medicine, but fell to lower levels between doses. Blood levels of gentamicin remained within a therapeutic range 57% of the time in infants treated once daily, but only 7% of the time in infants treated twice daily. Once-daily dosing was more effective, less expensive, and required fewer laboratory tests than the twice-daily dosing schedule.
Objectives. To compare performance and cost analysis of two gentamicin regimens in infants [is greater than or equal to] 34 weeks' gestation requiring antibiotics for a 72-hour rule-out sepsis evaluation. A once-daily dosing (ODD) regimen of 4 mg/kg was compared with a standard twice-daily dosing (TDD) regimen of 2.5 mg/kg every 12 hours. Setting and Design. Infants at two university-affiliated Level III nurseries were prospectively temporally allocated to receive ODD (n = 27) or TDD (n = 28) as part of their 72-hour empirical antibiotic regimen. Performance of dosing regimens was based on target serum gentamicin concentrations (SGC) established prospectively as a peak of 5 to 10 [micro]g/mL and a trough of [is less than or equal to] 2 [micro]g/mL. SGC were determined by fluorescence polarization immunoassay on day 3 of therapy. Cost data were obtained by distributing a questionnaire to 15 pediatric pharmacy practice sites. Inquiries were made regarding hospital cost of drug acquisition, drug supplies, drug preparation and administration, and serum concentration analysis. Performance and cost data were then used to do a cost-effectiveness analysis. Results. Mean peak concentrations were higher with ODD (7.9 [+ or -] 0.2 [micro]g/mL) than TDD (6.7 [+ or -] 0.3 [micro]g/mL). Half of the patients in the TDD group had trough concentrations [is greater than] 2 [micro]g/mL, compared with none in the ODD group. Overall, 57% of the SGCs in the TDD group were outside the target concentration range versus 7% in the ODD group. Based on questionnaire results, a total 72-hour process cost of ODD versus TDD was compared for regimens with and without use of SGC analysis. If SGCs are obtained, more than 75% of the cost associated with gentamicin therapy is attributable to SGC analysis. Based on a cost-effectiveness analysis, ODD was the dominant dosing strategy in all categories analyzed. Conclusions. ODD of gentamicin at 4 mg/kg in neonates [is greater than or equal to] 34 weeks' gestation is the preferable treatment strategy based on: 1) significantly improved SGC performance compared with TDD; 2) elimination of the need for routine SGC collection in infants on short courses of therapy; and 3) significant antibiotic-associated hospital cost savings when compared with conventional therapy of TDD and SGC analysis. Pediatrics 1999;103: 594-598; gentamicin, dosing, once daily, drug concentrations, peak, trough, cost-effectiveness, pharmacoeconomics, neonate.
ABBREVIATIONS. ODD, once-daily dosing; TDD, twice-daily dosing; SGC, serum gentamicin concentration; C/E, cost-effectiveness. Gentamicin remains the gold standard as part of empirical antibiotic therapy for early-onset suspected or proven neonatal [...]
Objectives. To compare performance and cost analysis of two gentamicin regimens in infants [is greater than or equal to] 34 weeks' gestation requiring antibiotics for a 72-hour rule-out sepsis evaluation. A once-daily dosing (ODD) regimen of 4 mg/kg was compared with a standard twice-daily dosing (TDD) regimen of 2.5 mg/kg every 12 hours. Setting and Design. Infants at two university-affiliated Level III nurseries were prospectively temporally allocated to receive ODD (n = 27) or TDD (n = 28) as part of their 72-hour empirical antibiotic regimen. Performance of dosing regimens was based on target serum gentamicin concentrations (SGC) established prospectively as a peak of 5 to 10 [micro]g/mL and a trough of [is less than or equal to] 2 [micro]g/mL. SGC were determined by fluorescence polarization immunoassay on day 3 of therapy. Cost data were obtained by distributing a questionnaire to 15 pediatric pharmacy practice sites. Inquiries were made regarding hospital cost of drug acquisition, drug supplies, drug preparation and administration, and serum concentration analysis. Performance and cost data were then used to do a cost-effectiveness analysis. Results. Mean peak concentrations were higher with ODD (7.9 [+ or -] 0.2 [micro]g/mL) than TDD (6.7 [+ or -] 0.3 [micro]g/mL). Half of the patients in the TDD group had trough concentrations [is greater than] 2 [micro]g/mL, compared with none in the ODD group. Overall, 57% of the SGCs in the TDD group were outside the target concentration range versus 7% in the ODD group. Based on questionnaire results, a total 72-hour process cost of ODD versus TDD was compared for regimens with and without use of SGC analysis. If SGCs are obtained, more than 75% of the cost associated with gentamicin therapy is attributable to SGC analysis. Based on a cost-effectiveness analysis, ODD was the dominant dosing strategy in all categories analyzed. Conclusions. ODD of gentamicin at 4 mg/kg in neonates [is greater than or equal to] 34 weeks' gestation is the preferable treatment strategy based on: 1) significantly improved SGC performance compared with TDD; 2) elimination of the need for routine SGC collection in infants on short courses of therapy; and 3) significant antibiotic-associated hospital cost savings when compared with conventional therapy of TDD and SGC analysis. Pediatrics 1999;103: 594-598; gentamicin, dosing, once daily, drug concentrations, peak, trough, cost-effectiveness, pharmacoeconomics, neonate.
ABBREVIATIONS. ODD, once-daily dosing; TDD, twice-daily dosing; SGC, serum gentamicin concentration; C/E, cost-effectiveness. Gentamicin remains the gold standard as part of empirical antibiotic therapy for early-onset suspected or proven neonatal [...]