Case Study 1
A newborn female preterm infant with a gestational age of 26 weeks and a birth weight of 850 grams was delivered by cesarean section. She was admitted to the neonatal intensive care unit (NICU) because of respiratory insufficiency and was treated with ampicillin and gentamicin because of suspicion of a severe bacterial infection.
1. What is currently the dose of gentamicin that will be prescribed to this preterm infant?
A. 2.5 mg/kg three times a day
B. 2.5 mg/kg twice a day
C. 2.5 mg/kg once a day
D. 4-5 mg/kg once every 36 hrs
After the infant is treated for 48 hrs with these broad spectrum antibiotics, her blood cultures do not show any bacterial growth, and the attending neonatologist decides to discontinue the antibacterial treatment.
Three weeks later, this little infant develops unstable temperature, decreased tolerance of oral feedings and increased episodes of apnea/bradycardia and is again suspected of having a several bacterial infection. After obtaining cultures, the attending neonatologist decides to start broad spectrum antibiotics including again gentamicin.
2. This time, the clearance and volume of distribution of gentamicin will be different from the clearance and volume of distribution of gentamicin during the first treatment of this young infant. What do you expect to happen?
A. Clearance will be more and volume of distribution will be larger
B. Clearance will be less and volume of distribution will be larger
C. Clearance will be more and volume of distribution will be smaller
D. Clearance will be less and volume of distribution will be smaller
Several weeks later, she develops severe gastro-esophageal reflux and the attending neonatologist decides to prescribe a proton pump inhibitor. At that time, it is known that she has the following genotype of CYP2C19: *1/*17. As a consequence, she will metabolize CYP2C19 substrates faster than individuals with a wild type genotype (*1/*1).
3. Which statement about proton pump inhibitors is correct?
A. All proton pump inhibitors have the same dependency
B. All proton pump inhibitors are not influenced by CYP2C19
C. Omeprazole is more dependent on CYP2C19 than Pantoprazole
D. Pantoprazole is more dependent on CYP2C19 than Omeprazole
Case Study 2
A fullterm newborn male infant is delivered urgently by caesarean section because of signs of perinatal asphyxia. After delivery, he is admitted to the NICU for further evaluation and treatment. Clinical and laboratory evaluations indicate impaired renal function due to this perinatal asphyxia. The attending neonatologist wants to prescribe antibacterial treatment and needs help to decide whether and how to adjust the dose of gentamcin in this infant.
1. What would be the best advice?
A. No need to adjust dosing of antibacterial agents in this infant
B. Same dose can be used but dosing frequency needs to be increased
C. Same dose can be used but dosing frequency needs to be decreased
D. A higher dose needs to be used but no need to change the dosing frequency
Presented by the PhRMA Foundation Safe and Effective Prescribing Project
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