Abstract
It is difficult to achieve a therapeutic range rapidly because of individual variations in clearance (Cl) and distribution volume (Vd). Sheiner et al prospectively validated a Bayesian approach to individualizing Cl and Vd in adults. We have studied the usefulness of this microcomputer approach in the neonate. The charts of 11 newborns treated with theophylline were retrospectively reviewed. Average values for Cl and Vd taken from the literature were assumed for each infant. Initial estimates were revised with the first serum level. Individualized Cl and Vd were used to predict the second theophylline level. Predictions were not significantly different from measured levels. We found that Bayesian theophylline dosing program could estimate an individual neonate's theophylline Cl and Vd with as few as one serum level with acceptable accuracy.
Gentamicin dosing decisions were then studied prospectively. Serum levels were obtained immediately before the second dose. Published values for Cl and Vd were individualized using the trough level and the Bayesian program. Dose revisions were made using individual Cl and Vd. Followup levels were obtained in 72-96 hours. In 19 of 20 infants, followup levels were in the therapeutic range. Predictions were not significantly different from measured levels. We conclude that dosing schedules which are individualized based on 1 serum level and the Bayesian microcomputer program make achieving therapeutic levels quick and accurate.
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Murphy, G., Weisman, L. & Peck, C. 398 AN IMPROVED APPROACH TO NEONATAL THERAPEUTICS. Pediatr Res 19, 177 (1985). https://doi.org/10.1203/00006450-198504000-00428
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DOI: https://doi.org/10.1203/00006450-198504000-00428
