ABSTRACT
A neonate born at 25 + 1/7 weeks developed ventilator-associated pneumonia at 29 + 3/7 weeks post-menstrual age with Escherichia coli that was originally sensitive to gentamicin. After 3 days of treatment with gentamicin, the minimum inhibitory concentration (MIC) changed from less than 1 mg/L to more than 16 mg/L. It appears that suboptimal gentamicin dosing led to the development of gentamicin resistance. As the patient was not improving clinically, the antibiotics were changed once the gentamicin resistance was identified. To minimize resistance and treatment failure, clinicians should consider the patient-specific pharmacokinetic parameters, achieved peak level, and the amount of time the gentamicin level will remain below the MIC of the organism being treated.
Subject(s)
Gentamicins , Pneumonia, Ventilator-Associated , Anti-Bacterial Agents/therapeutic use , Escherichia coli , Humans , Infant, Newborn , Microbial Sensitivity Tests , Pneumonia, Ventilator-Associated/diagnosis , Pneumonia, Ventilator-Associated/drug therapyABSTRACT
We report 6 cases of intravenous levofloxacin use to treat multidrug-resistant nosocomial respiratory infections in neonates with a postmenstrual age ranging from 27 to 42 weeks. Because of a lack of neonatal-specific information for levofloxacin, the usual pediatric dosage (10 mg/kg per dose every 12 hours) was used in these patients. Clinical cure occurred in 5 of the 6 patients. Only minimal short-term adverse effects were noted.
ABSTRACT
Infants receive many painful immunizations before they are 2 years old. The purpose of this study was to evaluate if topical tetracaine reduces the pain of intramuscular palivizumab compared to placebo. There were two study injections, one with tetracaine and one with placebo. Pain was scored by their parents and a pediatric nurse. Topical tetracaine was not associated with a significant reduction in pain score, although it did lead to faster recovery times. Additional pain-reduction strategies are required.
Subject(s)
Anesthetics, Local/therapeutic use , Antibodies, Monoclonal/adverse effects , Antiviral Agents/adverse effects , Injections, Intramuscular/adverse effects , Pain/prevention & control , Tetracaine/therapeutic use , Administration, Cutaneous , Antibodies, Monoclonal, Humanized , British Columbia , Child, Preschool , Double-Blind Method , Female , Humans , Infant , Male , Pain/diagnosis , Pain/etiology , Pain Measurement , Palivizumab , Parents/psychology , Pilot Projects , Respiratory Syncytial Virus Infections/prevention & control , Statistics, Nonparametric , Treatment Outcome , Videotape RecordingABSTRACT
BACKGROUND: Magnesium sulphate is a high-risk medication that is used extensively for prophylaxis and treatment of eclampsia. To accommodate recommendations related to fluid restrictions and patient safety, a protocol was developed for the administration of 20% magnesium sulphate. OBJECTIVES: To determine whether administration of 20% magnesium sulphate increased the risk of phlebitis relative to 2% to 8% magnesium sulphate solutions, to determine if the institution's protocol for administration of 20% magnesium sulphate reduced errors during administration, and to identify strategies to further reduce potential errors. METHODS: A retrospective chart audit was undertaken for patients who had received magnesium sulphate for prophylaxis of eclampsia from December 2004 to December 2007. A failure mode and effect analysis was used to identify additional safety strategies. RESULTS: A total of 47 patients received magnesium sulphate according to the old administration protocol (2% to 8% solution) and 29 according to the new protocol (20% solution). No evidence of phlebitis was documented for any of these 76 patients. A few errors occurred with changes in rates or concentrations and because of failure to reset the pump after the loading dose, but there was no documented harm to any of the patients. Strategies to further reduce errors in the administration of magnesium sulphate included development of preprinted orders, use of 20% magnesium sulphate for all infusion rates, changes to pump settings to enable use of fractional infusion rates, preparation of magnesium sulphate in mini-bags in the pharmacy, double-check of pump settings by nurses, anesthesiology consult, and distribution of protocols to all areas in the hospital (to limit errors associated with patient transfers). CONCLUSIONS: There was no documented phlebitis, and fewer errors occurred when 20% magnesium sulphate was used. Several additional strategies were identified to reduce errors in the administration of this high-risk medication.
