Impact of Compilation and Implementation of the ...
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Impact of Compilation and Implementation of the ...
Dec 21, 2010 - Theophylline Therapeutic Monitoring Guidelines in. Apnea of Prematurity ... possesses very narrow therapeutic index and requires a skilled.
12/21/2010
Impact of Compilation and Implementation of the Theophylline Therapeutic Monitoring Guidelines in Apnea of Prematurity (AOP) Muhammad Hammad*, Syed Shamim Raza*, Abdul Latif Sheikh*, Syed Rehan Ali**, Maqbool Qadir** *Department of Pharmacy Services, **Department of Pediatrics, Aga Khan University Hospital, Karachi ‐ Pakistan
Background:
Babies with Inappropriate Serum Levels – Pre Vs Post
The methylxanthine derivatives have been used for more than 30 years to treat apnea of prematurity (AOP). Today, they are among the most commonly prescribed drugs in neonatal medicine. Methylxanthines reduce the frequency of idiopathic apnea and the need for mechanical ventilation by acting as non‐specific inhibitors of adenosine. Theophylline, a methylxanthine derivative possesses very narrow therapeutic index and requires a skilled therapeutic monitoring. In our hospital, 17% babies detected with inappropriate serum concentration of theophylline resulting in harmful effects of the drug. Sufficient literature is available for the principles of theophylline therapeutic monitoring as anti‐ asthma, though, consistent literature support lacks for the therapeutic monitoring of theophylline in neonates when used for AOP.
0.18
17%
0.16 0.14 0.12 0.1
9%
0.08 0.06 0.04 0.02 0 Pre
Post
Figure # 01
Post‐Implementation Serum Levels of Theophylline 2% 18% Subtherapeutic Supratherapeutic Therapeutic
98%
Methodology: Literature search was carried out to compile up the principles of theophylline therapeutic monitoring in AOP. Primary literature was searched on Pubmed, Ovid and MEDLINE; tertiary literature was consulted from text books and clinical manuscripts of pharmacology, pharmacokinetics, pharmacotherapy, neonatology, toxicology, toxic okinetics and drug information handbooks. handbooks The guidelines were introduced in the NICU as flow charts. Physicians were educated to comply with the guidelines. Pre and post data was collected.
Figure # 02
Babies with Tachycardia, Pre Vs Post
43%
57% Pre Post
Results: The guidelines and rudiments of theophylline therapeutic monitoring in AOP were set up as a document and disseminated to relevant staff. staff Implementation of the guidelines resulted in 71.5% reduction in inappropriate (sub/supra therapeutic) serum levels of theophylline (fig: # 1,2) and less number of babies with tachycardia while on theophylline (fig: # 3)
Conclusion:
Figure # 03
Adherences to the guidelines could be attributed to desired serum levels of theophylline for apnea of prematurity and decreasing the adverse drug events. The need is to review the current literature as on‐going basis and implement the evidence based practices.
