Extended-interval aminoglycoside administration for children: a meta-analysis

Area of Science:

• Pharmacology
• Pediatric Infectious Diseases
• Clinical Trials

Background:

• Aminoglycoside dosing strategies (multiple daily dosing vs. once-daily dosing) have been debated.
• Once-daily dosing (ODD) offers potential advantages due to aminoglycosides' concentration-dependent activity and postantibiotic effect.
• Unique pharmacokinetic properties of aminoglycosides may favor ODD for reduced toxicity.

Purpose of the Study:

• To compare the efficacy and toxicity of once-daily dosing (ODD) versus multiple daily dosing (MDD) of aminoglycosides in pediatric patients.
• To synthesize evidence from randomized controlled trials to inform clinical practice.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) in pediatric populations.
• Searched PubMed, Embase, and Cochrane Controlled Trials Registry for eligible studies.
• Extracted data on clinical failure, microbiologic failure, nephrotoxicity, and ototoxicity.

Main Results:

• No significant difference in clinical or microbiologic failure rates between ODD and MDD, with trends favoring ODD.
• No significant difference in primary nephrotoxicity; ODD showed significantly lower secondary nephrotoxicity.
• No significant difference in ototoxicity, though reporting was incomplete; rates were low for both regimens.

Conclusions:

• Available randomized evidence supports the adoption of once-daily dosing (ODD) for aminoglycosides in pediatric practice.
• ODD offers similar or potentially improved efficacy and safety compared to multiple daily dosing (MDD).
• This dosing approach simplifies administration, minimizes costs, and is supported by current evidence.