Increased dosing requirements for amikacin in burned children

Pharmacokinetic analysis was performed on 38 thermally injured children ranging from 3 months to 18 years of age with per cent total body surface area burns (%TBSA) of 17-87%. All patients needed increased dosing requirements for amikacin to maintain therapeutic serum levels. There was a wide variation in the volumes of distribution and an inverse relationship with age, i.e., the volume of distribution tended to be lower in the older children. The results indicate the manufacturer's recommended dose will result in subtherapeutic serum levels and we recommended initial doses of at least 10 mg/kg administered every 6 h. Dosage adjustments using individualized pharmacokinetics should then be performed within 24 h of initiation of therapy. The study documents the importance of dosage individualization for amikacin in the burned child.