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[Fundamental study of amikacin in the newborn]
Insights
Amikacin (AMK) antibiotic levels were evaluated in newborns. Higher AMK doses resulted in increased blood concentrations, with longer half-lives observed in younger infants, indicating altered pharmacokinetics in neonates.
Area of Science:
- Pharmacology
- Neonatal Medicine
- Infectious Diseases
Context:
- Amikacin (AMK) is a crucial aminoglycoside antibiotic for treating Gram-negative bacterial infections.
- Established efficacy and safety in children and mature infants, but limited data in newborns.
- Need to understand AMK pharmacokinetics in the neonatal population for optimized dosing.
Purpose:
- To evaluate the pharmacokinetics of amikacin in newborn infants.
- To determine amikacin blood concentrations and half-lives following different intramuscular and intravenous administrations.
- To assess the impact of exchange transfusion on amikacin blood levels in neonates.
Summary:
- Amikacin administration in 13 mature and 8 premature neonates via IM injection or IV infusion yielded dose-dependent blood concentrations ranging from 4.47-37.7 mcg/ml.
- Observed amikacin half-lives varied from 1.88 to 9.66 hours, with longer durations in younger infants.
- Exchange transfusion in 5 neonates reduced amikacin blood concentrations by a mean of 32.3%.
Impact:
- Provides essential pharmacokinetic data for amikacin use in neonates.
- Informs clinical decision-making regarding amikacin dosing strategies in this vulnerable population.
- Highlights the need for careful monitoring of amikacin levels in neonates, especially those undergoing exchange transfusion.
Abstract:
Amikacin (AMK) is one of the aminoglycoside antibiotics, derived from kanamycin A. It has a broad spectrum against Gram-negative rods but its usefulness is mainly in the efficacy against Gram-negative rods which do not respond to commonly used kanamycin and gentamicin. The efficacy and the safety of AMK have been confirmed in children and mature babies. In the trial reported here, we evaluated AMK in newborn. 1. AMK was administered to 13 mature and 8 premature babies via intramuscular injection or intravenous drip infusion for 30 minutes or 1 hour and its blood concentrations were determined. These administrations resulted in blood concentrations 4.47-9.67 mcg/ml with dosage levels 2.3 mg/kg (mean 6.92 +/- 1.66 mcg/ml), 5.86-26.1 mcg/ml with 5-6 mg/kg (mean 15.4 +/- 4.63 mcg/ml) and 27.5-37.7 mcg/ml with 7.5 mg/kg (mean 31.0 +/- 4.76 mcg/ml). Blood half-lives were 1.88 to 9.66 hours, showing longer half-lives in younger subjects. 2. Exchange transfusion (150-180 ml/kg) was performed in 5 mature babies and the variation of blood concentrations of AMK was studied. The study showed that blood concentrations of AMK after the exchange transfusion were 25.6-41.5% (mean 32.3 +/- 5.4%) of the levels detected before the transfusion.