Appropriateness of gentamicin therapeutic drug monitoring at a Middle Eastern tertiary hospital setting: a retrospective evaluation and quality audit.

Introduction: The use of gentamicin in the treatment of infectious diseases requires frequent monitoring to attain the best treatment outcomes. Objective: This study aimed to evaluate the appropriateness of gentamicin therapeutic drug monitoring (TDM) at a tertiary care hospital in Qatar. Methods: A one-year quantitative retrospective chart review of all gentamicin TDM records was conducted. Evidence-based criteria were applied to evaluate the appropriateness of gentamicin TDM in terms of indication, sampling times, and post-analytical actions. Results: Out of 59 captured gentamicin TDM records, 58 gentamicin samples were eligible for evaluation. Overall, gentamicin TDM appropriateness was achieved in 50% (n = 29) of the evaluated records. However, 12% (n = 7) of gentamicin drug concentrations were below the assay quantification limits or were not sampled appropriately. Inappropriate post-analytical actions (22.4%, n = 13) and inappropriate sampling times (44.8%, n = 26) were recorded. Most of the gentamicin blood samples (n = 43; 74.2%) were taken appropriately at steady-state. Inappropriate sampling time relative to the last dose was captured in 31% (n = 18) of the cases. Although 27.6% (n = 16) of gentamicin concentrations were non-therapeutic, continuing gentamicin dosing without adjustment was the most frequent post-analytical action (69.8%, n = 37). Gentamicin dose regimen continuations, dose regimen decreases and dose regimen discontinuations were inappropriately applied in 27% (n = 10), 25% (n = 2) and 14% (n = 1) of the times, respectively. Conclusion: Suboptimal gentamicin TDM practices exist in relation to sampling time and post-analytical actions. Studies exploring setting-specific reasons behind inappropriate TDM practices and methods of its optimisation are needed.

Poor vitamin D supplementation in infants. Cross-sectional study of maternal practices and awareness of vitamin D supplementation in infants in Al-Ahsa, Eastern Saudi Arabia.

OBJECTIVE: To describe the maternal practices and awareness of vitamin D supplementation in infants, and factors affecting these practices in Eastern Saudi Arabia. METHODS: A cross-sectional study was conducted with 606 mothers attending community-based primary health centers in Al-Ahsa, Eastern Saudi Arabia between March and April 2012. A 22-item questionnaire was used to assess the socio-demographic data of both infants and mothers, feeding methods, nursing practices including vitamin D supplementation, and mothers' awareness regarding vitamin D supplementation in infants by face-to-face interview. Chi-squared test was used to assess significant differences among these practices. Significant variables were subjected to multiple logistic regression. A p-value of 0.05 was used to indicate statistical significance. RESULTS: The response was 91%. Forty percent of mothers were not giving their infants vitamin D at the time of contact. More than 40% of the mothers were not aware of, and they were not offered advice on the need to give vitamin D to their infants. Lack of physician advice (odds ratio 42), and poor maternal awareness of the necessity to give vitamin D to their infants (odds ratio - 2.676) are the most significant factors related to the absence of vitamin D supplementation in infants (p<0.05). CONCLUSION: Vitamin D supplementation during the first year of infancy is low. This is most likely due to the lack of maternal awareness and physician neglect in providing advice to mothers regarding vitamin D supplementation in infants.