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Aminoglycoside volume of distribution in pediatric patients
1College of Pharmacy, University of Saskatchewan, Saskatoon, Canada.
Insights
Pediatric patients have a larger apparent volume of distribution (Vd) for aminoglycoside antibiotics than adults. This finding necessitates adjusting pediatric dosage regimens for optimal therapeutic outcomes.
Area of Science:
- Pharmacology
- Pediatric Medicine
- Drug Dosing
Background:
- Aminoglycoside antibiotics are crucial in treating pediatric infections.
- Accurate pharmacokinetic parameter estimation is vital for effective and safe drug administration in children.
Purpose of the Study:
- To determine the apparent volume of distribution (Vd) of aminoglycoside antibiotics in pediatric patients.
- To compare pediatric Vd with established adult values.
- To inform appropriate dosage adjustments for pediatric populations.
Main Methods:
- Retrospective analysis of pharmacokinetic data from 218 pediatric patients (ages 1-16) with normal renal function.
- Utilized the Sawchuk-Zaske method for pharmacokinetic parameter calculation.
- Data sourced from Saskatoon University Hospital and Regina General Hospital aminoglycoside monitoring services.
Main Results:
- The average Vd for pediatric patients was 0.34 L/kg, with a half-life of 2.3 hours.
- A significantly larger Vd was observed in pediatric patients compared to the adult Vd of 0.20 L/kg.
- Younger children (1-4.9 years) exhibited a larger Vd than older pediatric groups, though Vd did not strongly correlate with age.
Conclusions:
- The apparent volume of distribution (Vd) for aminoglycosides in pediatric patients is significantly greater than in adults.
- Current adult Vd estimates are not suitable for pediatric dosing.
- Dosage regimens for aminoglycosides in children require adjustment to account for their larger Vd.
Abstract:
Pharmacokinetic parameters of three aminoglycoside antibiotics were studied retrospectively in 218 pediatric patients to determine an apparent volume of distribution (Vd) for this age group and to determine if Vd is significantly different in pediatric patients compared with adults. Data on patients considered for inclusion in the study were obtained from the files of the aminoglycoside monitoring services at Saskatoon University Hospital and Regina General Hospital. Both services use a computer program that calculates pharmacokinetic parameters using the Sawchuk-Zaske method. Children between the ages of 1 and 16 years with normal renal function from whom serum concentration had been obtained were included in the study. Exclusion criteria included abnormal or unstable renal function, cystic fibrosis, and pregnancy. The mean age of the pediatric group was 8.65 +/- 5.37 years. Average values for Vd and half-life were 0.34 L/kg and 2.3 h, respectively. No strong correlation was found between the Vd (L/kg) and age. The patients were subdivided into three age groups: 1-4.9 years, 5-9.9 years, and 10-16 years. Group 1 (1-4.9 years) had a larger Vd than the other groups and the Vd of all three groups were significantly different from the estimated Vd of 0.20 L/kg for adult patients. A "normal" pediatric value for the Vd of aminoglycosides could not be determined; however, the Vd in children is significantly larger than the Vd in adults and dosage regimens should be adjusted accordingly.