Department of Pharmaceutical Sciences
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Item Monitoring of gentamicin concentrations in obstetrics and gynaecology patients at Windhoek Central Hospital and Katutura Intermediate Referral Hospital(University of Namibia, 2018) Singu, Bonifasius SiyakaThe aim of this study was to assess whether the gentamicin dosing strategy as presently performed at Katutura Intermediate Referral Hospital and Windhoek Central Hospital produces gentamicin serum concentrations that are within the recommended therapeutic ranges. This was a quantitative, prospective and observational/non-interventional study. Patients (n=35) Patients who were admitted and receiving gentamicin therapy in the obstetrics & gynaecology wards of the two hospitals (Katutura Intermediate Referral Hospital and Windhoek Central Hospital) were recruited and two blood samples taken from each patient. The first sample was drawn at 1 hour after starting the infusion and a second sample after 6 hours. Serum gentamicin and serum creatinine concentrations were determined using a Thermo Scientific Indiko Plus® autoanalyser and plots of serum gentamicin concentration vs time on semi-logarithmic paper were used to deduce the pharmacokinetic characteristics. Data were analyzed using descriptive statistics. The study revealed that 80.0% of non-PID patients received doses that were lower than the 5-7 mg/kg recommended for once daily dosing. In addition, 86.3% of patients had Cmax values that were below the recommended 17-25 μg/mL. All patients treated against PID had their doses falling within the recommended 3-5 mg/kg, but no guiding literature was found to act as a reference for the serum gentamicin levels in PID patients. The results from this study led to the following recommendations: i) discontinue the use of standard dosing of gentamicin, ii) use mg/kg dosing method in determining gentamicin doses, iii) monitor the gentamicin levels to ensure safety and efficacy, iv) studies to evaluate the antimicrobial effectiveness of the 3-5 mg/kg PID dose should be carried out.Item Plasma concentration and eGFR in preterm and term neonates receiving gentamicin or successive amikacin therapy(BMC Pediatrics, 2023) Singu, Bonifasius S.; Ndeunyema, Milka N.; Ette, Ene I.; Pieper, Clarissa H.; Verbeeck, Roger K.Background: Gentamicin and amikacin are aminoglycoside antibiotics which are renally excreted and known to be nephrotoxic. Estimate of glomerular filtration rate (eGFR) per body surface area is lower in neonates than in adults and exposure to these drugs could lead to more suppression in kidney function. The aim of this study was to determine maximum and minimum plasma concentrations (Cmax and Cmin), time to reach Cmin levels of gentamicin and amika-cin, and to assess eGFR in preterm and term neonates. Methods:Two groups of patients were recruited, 44 neonates receiving gentamicin (5 mg/kg/24 h) and 35 neonates receiving amikacin (15 mg/kg/24 h) by slow intravenous injection. Patients on amikacin had been on gentamicin before being switched to amikacin. Two blood samples were drawn for the determination of the maximum and minimum plasma concentration. Primary outcomes were determination of Cmax, Cmin, and the time it took to clear the aminoglycoside to a plasma concentration below the toxicity threshold (gentamicin: < 1 mcg/mL; amikacin: < 5 mcg/mL. Results: Therapeutic range for Cmax of gentamicin (15–25 mcg/mL) or amikacin (30–40 mcg/mL) was achieved in only 27.3 and 2.9% of neonates, respectively. Percentage of neonates reaching plasma concentrations below the tox-icity threshold within the 24-hour dosing interval was 72.7% for gentamicin and 97.1% for amikacin. Positive correla-tion between gentamicin clearance and postnatal age borderline statistical significance (p=0.007), while the correla-tion between amikacin clearance and postnatal age was poor and not statistically significant (r2=− 0.30, p= 0.971). Conclusion: Although eGFR decreased significantly as a function of postnatal age in neonates receiving amikacin, the majority (91.4%) of these neonates were able to clear the drug to < 5 mcg/mL within a 24-hour dosing interval. Keywords: Neonates, Kidney function, Gentamicin, Amikacin, Nephrotoxicity