Population pharmacokinetics of amikacin in suspected cases of neonatal sepsis.

AIMS: This study aimed to characterize the population pharmacokinetic parameters of intravenously administered amikacin in newborns and assess the effect of sepsis in amikacin exposure. METHODS: Newborns aged ≥3 days who received at least 1 dose of amikacin during their hospitalization period were eligible for the study. Amikacin was administered intravenously during a 60-min infusion period. Three venous blood samples were taken from each patient during the first 48 h. Population pharmacokinetic parameter estimates were obtained using a population approach with the programme NONMEM. RESULTS: Data from 329 drug assay samples were obtained from 116 newborn patients (postmenstrual age [PMA] 38.3, range 32-42.4 weeks; weight 2.8, range 1.6-3.8 kg). Measured amikacin concentrations ranged from 0.8 to 56.4 mg/L. A 2-compartment model with linear elimination produced a good fit of the data. Estimated parameters for a typical subject (2.8 kg, 38.3 weeks) were clearance (Cl = 0.16 L/h), intercompartmental clearance (Q = 0.15 L/h), volume of distribution of the central compartment (Vc = 0.98 L) and peripheral volume of distribution (Vp = 1.23 L). Total bodyweight, PMA and the presence of sepsis positively influenced Cl. Plasma creatinine concentration and circulatory instability (shock) negatively influenced Cl. CONCLUSION: Our main results confirm previous findings showing that weight, PMA and renal function are relevant factors influencing newborn amikacin pharmacokinetics. In addition, current results showed that pathophysiological states of critically ill neonates, such as sepsis and shock, were associated with opposite effects in amikacin clearance and should be considered in dose adjustments.

Factores que influyen en la adherencia terapéutica de los hipertensos del Centro Metropolitano Essalud Cusco / Factors that influence the therapeutic adherence of the hypertense ones of the Metropolitan Center Essalud Cusco

La adherencia terapéutica de los hipertensos, es un proceso complejo asociado a múltiples factores, como: los socioeconómicos, los relacionados con la enfermedad, con el tratamiento, con el paciente y con el personal de salud. La investigación tiene como objetivo determinar los factores que influyen en la adherencia terapéutica de los hipertensos del programa de Hipertensión Arterial del Centro Metropolitano EsSalud, Cusco,2008. El estudio es de tipo correlacional, transversal, retrospectivo, con una muestra de 180 usuarios, de una población 1022, se recolectaron los datos mediante una entrevista con un cuestionario estructurado; las principales conclusiones son: Los factores que influyen en la baja adherencia terapéutica son; el bajo ingreso económico , el poco conocimiento de los síntomas y complicaciones de la hipertensión arterial, el tomar a diario los medicamentos, molestia de realizar ejercicio, efecto negativo percibido del tratamiento, poca asistencia a las reuniones de grupo, poco tiempo para la consulta de enfermería, y al grupo etario adulto mayor. Los usuarios del Programa de Hipertensión Arterial del Centro Metropolitano del Hospital Nacional Sur Este EsSalud del Cusco, tienen adherencia terapéutica parcial (72,8%).

The terapeutic adherence of hypertensives persons, is related to mani factors, such as socioeconomic, those associated with the disease, with health staff. The resources aims to identify the factors that influence on the therapeutic adherence of hypertensive persons of Hypertension Program of Metropolitan Center EsSalud, Cusco, 2008. It is a correlational cross-sectional, retrospective, with a sample of 180 users in a population of 1022, were collected data through the interview with a structured questionnaire, the main conclusions are: Factors that influence in the low adherence therapy are; lowincome, the little knowledge of the symptoms and complications of hypertensión, take daily medication, discomfort with the exercise, perceived negative effect from the treatment, poor attendance at meetings, little time for nursing consultation, and the age group of seniors. Users of Hypertensión Program of Metropolitam Center EsSalud from Cusco, has therapeutic adherence partial (72.8%).