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38 Accuracy of antibiotic concentrations in drug dispensing: a risk for low doses in neonates

Abstract

Introduction Antibacterial therapy plays a crucial role in neonatal infections. Antibacterial efficacy is closely related to the actual dose given to the neonates. Thus, we aimed to evaluate the factors affecting actual dose of intravenous antibiotics in the dispensing process to ensure the precision therapy in neonates.

Methodology Meropenem, cefoperazone/sulbactam and piperacillin/tazobactam with two drug strengths were used as representative drugs to evaluate three different drug dispensing methods. Method A was once dilution method, in which the drug powder was dissolved by a small volume of 5% glucose and then diluted once to a certain concentration. Method B was the same with method A except that the volume of 5% glucose used to dissolve the drug powder was doubled. Method C was double dilution method, in which the drug powder was dissolved by 5% glucose and then diluted twice to a certain concentration. The drug concentration was measured by high performance liquid chromatography. The relative error (RE) of the drug concentration was used to evaluate the accuracy of the preparation.

Results A total of 648 drug concentrations were measured. The average of RE absolute value of the drug concentrations obtained by method B was 1.4% with small drug strength, and 6.7% with large drug strength, respectively. The RE absolute value of drug concentration obtained by method A and C was larger than that by method B. The average of RE absolute value of the drug concentrations obtained by method A was 7.8% with small drug strength, and 15.6% with large drug strength, respectively; and the values obtained by method C was 4.5% with small drug strength, and 6.9% with large drug strength, respectively.

Conclusion The factors affecting actual dose of intravenous antibiotics in the dispensing process were the volume of solvent and the drug strength, as well as the dilution times for drugs with poor stability. Method B was more suitable for neonatal drug dispensing because of its high accuracy and simple operation.

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