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[Kinetics of multiple-dose amikacin in the newborn infant]

A Olivesi, J Camboulives, C Charrel

    Annales De L'Anesthesiologie Francaise
    |January 1, 1981
    PubMed

    Insights

    Amikacin dosing in neonates requires careful consideration due to unpredictable accumulation, particularly in premature infants. Adjustments are crucial to prevent ototoxicity, with reduced dosages and serum level monitoring recommended.

    Area of Science:

    • Pharmacokinetics
    • Neonatal Medicine
    • Infectious Diseases

    Context:

    • Intensive care unit (ICU) hospitalization of neonates.
    • Administration of amikacin via intramuscular injection.
    • Limited pharmacokinetic data available for neonatal populations.

    Purpose:

    • To characterize the pharmacokinetic profile of amikacin in neonates.
    • To identify factors influencing amikacin accumulation and elimination.
    • To provide dosing recommendations for safe and effective amikacin therapy in neonates.

    Summary:

    • A pharmacokinetic study involving 12 neonates in the ICU investigated amikacin serum levels after intramuscular injections.
    • Elevated serum amikacin levels (>10 µg/mL) were observed in most neonates within the first three hours.
    • Unpredictable amikacin accumulation occurred, especially in premature infants (<5 days old, <2 kg birth weight), influenced by renal function and clinical outcomes.
    • Half-life ranged from 3-8 hours, and plasma clearance was 8.9-14 mL/min/1.73 m².
    • Elimination is primarily dependent on renal function, highlighting the risk of ototoxicity.

    Impact:

    • Suggests a revised amikacin dosage of 10 mg/kg/24h for neonates.
    • Emphasizes the need for therapeutic drug monitoring, including peak and trough serum levels.
    • Aims to optimize amikacin efficacy while minimizing the risk of adverse effects like ototoxicity in vulnerable neonates.

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