Fecha de recepción: 02/11/2017 – Fecha de aceptación: 31/10/2018
Álvarez Martín T1, Bellés Medall MD2, Mendoza Aguilera M1, Pascual Marmaneu O1, García Martínez T1, Ferrando Piqueres R3
1 FEA Farmacia Hospitalaria
2 Dr. en Farmacia. Jefe de Sección en Farmacia Hospitalaria
3 Dr. en Farmacia. Jefe Servicio en Farmacia Hospitalaria
Servicio de Farmacia. Hospital General Universitario de Castellón. Castellón (España)
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Correspondencia:
Tamara Álvarez Martín w Hospital General Universitario de Castellón (Servicio de Farmacia) w Avda. Benicassim, s/n w 12004 Castellón (España)
tamara_am_89@hotmail.com
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Summary
Introduction: The aim of the study was to update the initial empiric dosage protocol of vancomycin in neonates implemented in our hospital in 2008 to achievement trough concentrations above 10 mcg/mL after the first pharmacokinetic monitoring.
Material and methods: A retrospective observational study of vancomycin monitoring in neonates was carried out for three years. The following data were collected: weight, postnatal age, gestational age, dose, date of last administration and date of extraction. The vancomycin concentrations that would be achieved with the proposed new guidelines were simulated. To validate the update proposal in clinical practice, the neonates who received vancomycin in our center were monitored for two years postimplantation of the new protocol.
Results: Only 23.5% of the neonates achieved trough concentrations above than 10 mcg/mL before updating the protocol. The new proposal consisted of dose/interval dosing modification. It was observed that 75% of the neonates achieved therapeutic concentrations in the first pharmacokinetic monitoring with the Bayesian estimate. After its implementation in clinical practice, the validation of this new dosing regimen was carried out and a 77.8% of the neonates that followed the new protocol achieved trough concentrations above than 10 mcg/mL after the first determination.
Conclusions: The updating of the protocol provides more adequate plasma concentrations from the beginning of the treatment, which will help achieve better clinical results and reduce the number of monitoring in this group of patients.
Key Words: Vancomycin, infant, dosage.
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Download PDF: Actualización de un protocolo de dosificacion inicial de vancomicina en neonatos