Neonates aminoglycosides

There is an increase in the urinary output of tubular marker proteins after aminoglycoside administration (102). Determination of A-acetyl-beta-o-glucosaminidase activity in the urine may be used as a screening test to facilitate early detection of the nephrotoxic effect of aminoglycosides (110). Urine chemiluminescence may aid in the detection of neonatal aminoglycoside-induced nephropathy (111). 

Neonate Group streptococcus, E coli, Listeria Ampicillin + cephalosporin (third-generation) Ampicillin + aminoglycoside, chloramphenicol, meropenem... 

INDOMETACIN AMINOGLYCOSIDES T amikacin, gentamicin, and vancomycin levels in neonates Uncertain indometacin possibly 1 renal clearance of these aminoglycosides Halve the dose of antibiotic. Uncertain whether this applies to adults but suggest check levels. Otherwise use an alternative NSAID... 

Weight-related priming doses of aminoglycosides, aminophylline, digoxin and frusemide need to be larger for neonates than for older children. 

Elimination. Glomerular filtration, tubular secretion and reabsorption are low in the neonate (even lower in preterm babies) only reaching adult values in relation to body surface area at 2-5 months. Therefore drugs that are eliminated by the kidney (e.g. aminoglycosides, penicillins, diuretics) must be given in reduced dose after about 6 months. 

In a prospective study on the prevalence of hearing impairment in a neonatal intensive care unit population (a total of 942 neonates were screened), aminoglycoside administration did not seem to be an important risk factor for communication-related hearing impairment (148). In almost all cases, another factor was the more probable cause of the hearing loss (dysmorphism, prenatal rubella or cytomegaly, a positive family history of hearing loss, and severe perinatal and postnatal complications). 

High doses of parenteral penicillin can inactivate aminoglycosides (245). In patients receiving low doses of aminoglycosides because of reduced renal function this can be clinically important (246,247). Parenteral administration of these drugs in neonatal dosages does not seem to produce relevant inactivation, and so temporal separation of the infusions is not required (248). 

Daly IS, Dodge RA, Glew RH, Keroack MA, Bednarek FJ, Whalen M. Effect of time and temperature on inactivation of aminoglycosides by ampiciUin at neonatal dosages. J Perinatol 1997 17(l) 42-5. 

Aminoglycosides are almost exclusively eliminated by glomerular filtration. Elimination is dependent on cardiovascular and renal function, age, fever, other physiological factors and the V. The half-lives are usuaUy 1-2 h in normal adult horses but are increased in horses with renal dysfunction and in neonates. Increased dosage intervals must be used in these patients to prevent nephrotoxicity. The renal elimination of the aminoglycosides increases with age. The half-life of gentamicin is approximately 50% longer in 1-day-old than in 30-day-old foals. 

Supportive measures that would complement antimicrobial effectiveness and assist recovery of the animal from the infection should be provided. In neonatal animals, care must be taken to avoid a too-rapid rate of intravenous fluid administration. Fever may serve a useful purpose in infectious diseases, and the change in body temperature may be used to assess the progress of the infection. In the presence of an infectious diseased, the only indication for an antipyretic drug, e.g. aspirin or paracetamol (acetaminophen) in dogs but not in cats metamizole (dipyrone) or sodium salicylate administered intravenously to horses, is to decrease body temperature to below a dangerous level, 41°C (105.8°F). Concurrent therapy with a NSAID and an aminoglycoside antibiotic increases the risk of nephrotoxicity. If the infection is suspected to be contagious, the diseased and in-contact animals should be isolated. 

Some drugs may be less toxic in pediatric patients than in adults. Aminoglycosides appear to be less toxic in infants than in adults. In adults, aminoglycoside toxicity is related to both peripheral compartment accumulation and the individual patient s inherent sensitivity to these tissue concentrationsAlthough neonatal peripheral tissue compartments for gentamicin have been reported to closely resemble those of adults with similar renal function, gentamicin is rarely nephrotoxic in infants. This dissimilarity in the incidence of nephrotoxicity implies that newborn infants may have less inherent tissue sensitivity for toxicity than adults. 

In studies of the etiology of acute renal failure, medication-induced renal injury is reported as a major cause. In an analysis of over 2000 hospitalized patients, almost 100 experienced renal insufficiency and seven episodes were attributed solely to aminoglycoside therapy [11]. A high percentage of neonatal patients are treated with aminoglycosides and in the involvement of drugs in neonatal acute renal failure has increased up to 8-fold in the last 10 years [12]. 

NAG, along with other urinary enzymes, has been used to evaluate drug induced tubular damage as in the case of acetaminophen [113], 5-aminosalicyate/ sulfasalazine in patients being treated for inflammatory bowel disease [114], and the relative nephrotoxicity of differing aminoglycoside dose schedules in neonates [115]. Assess of the urinary excretion of NAG have also been reported in hypertensive patients [116] and in patients with chronic renal failure due to various causes [117]. However, to date, it is considered to be an ancillary but non-definitive marker of renal disease. 

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