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Increased dosing requirements for amikacin in burned children
R G Kopcha1, W K Fant, G D Warden
1Shriners Burns Institute, Cincinnati, Ohio 45219.
Insights
Burned children require higher amikacin doses than typically recommended to achieve therapeutic levels. Individualized pharmacokinetic dosing is crucial for effective treatment in pediatric burn patients to avoid subtherapeutic amikacin serum levels.
Area of Science:
- Pediatric pharmacology
- Burn critical care
- Antibiotic pharmacokinetics
Background:
- Severe burns in children significantly alter drug pharmacokinetics.
- Amikacin is frequently used in treating infections in burn patients.
- Standard dosing may not achieve therapeutic amikacin concentrations in pediatric burn survivors.
Purpose of the Study:
- To analyze the pharmacokinetics of amikacin in thermally injured children.
- To determine appropriate amikacin dosing strategies for this population.
- To evaluate the impact of age and burn severity on amikacin distribution.
Main Methods:
- Pharmacokinetic analysis of amikacin in 38 pediatric burn patients (3 months to 18 years).
- Patients had between 17-87% total body surface area burns (%TBSA).
- Serum amikacin levels were monitored to assess dosing requirements.
Main Results:
- All patients required increased amikacin dosing for therapeutic serum levels.
- A wide variation in volume of distribution was observed.
- A negative correlation between age and volume of distribution was noted, with lower volumes in older children.
Conclusions:
- Manufacturer's recommended amikacin doses lead to subtherapeutic levels in burned children.
- An initial dose of at least 10 mg/kg every 6 hours is recommended.
- Individualized pharmacokinetic dosing adjustments within 24 hours are essential for effective amikacin therapy in pediatric burn patients.
Abstract:
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.