Colistin Therapy in a 23-Week Gestational-Age Neonate with Multidrug-Resistant Acinetobacter baumannii Pneumonia

Multidrug-resistant pathogens are becoming more difficult to treat with significantly increasing infection rates. The lack of new antibiotics to combat these strains has led to the resurgence of older antibiotics. This case highlights the first reported use of colistimethate sodium treatment in a 23-week gestational-age neonate with multidrug-resistant Acinetobacter baumannii pneumonia who developed acute renal failure and seizures shortly after initiation of treatment

Impact of small‐for‐gestational age (SGA) status on gentamicin pharmacokinetics in neonates

We compared gentamicin pharmacokinetics among neonates born small‐for‐gestational age (SGA) and appropriate for gestational age (AGA). We further compared gentamicin pharmacokinetics in subgroups of AGA and SGA neonates born preterm and term and treated within and after the initial week of age. Steady state peak and trough serum gentamicin concentrations were used to calculate clearance (Cl), elimination constant (Kel), volume of distribution (Vd), and half‐life (t 1/2 ) in infants (n = 236) who received ≥48 hours therapy. Statistical analyses (SPSS 17.0) included chi‐square and the non‐parametric Mann–Whitney U ‐test. SGA infants treated early (≤7days) (n = 29) and at postmenstrual ages ≤32 weeks (n = 23) had significantly lower median Kel (0.069/h vs. 0.081/h and 0.067/h vs. 0.075/h) and clearance (0.58 mL/kg/min vs. 0.68 mL/kg/min and 0.46 mL/kg/min vs. 0.65 mL/kg/min), compared to those born AGA. There were no significant differences in pharmacokinetic profiles with later therapy or at more mature ages. The prolonged half‐life of gentamicin may need to be considered in dosing regimens for preterm SGA infants in the initial week of life.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102188/1/jcph190.pd