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Pharmacokinetics of amikacin in children with kwashiorkor
M K Hendricks1, P Van Der Bijl, D P Parkin
1Department of Paediatrics, University of Stellenbosch, Tygerberg, South Africa.
Insights
Pharmacokinetics of intravenous amikacin in children with kwashiorkor showed minimal changes. Current therapeutic amikacin regimens are likely sufficient for this pediatric population.
Area of Science:
- Pharmacology
- Pediatrics
- Clinical Pharmacy
Background:
- Kwashiorkor, a severe form of malnutrition, can alter drug pharmacokinetics.
- Understanding amikacin's behavior in children with kwashiorkor is crucial for effective treatment.
- Existing therapeutic guidelines may need adjustment based on pharmacokinetic data.
Purpose of the Study:
- To investigate the pharmacokinetics of intravenous amikacin in young children diagnosed with kwashiorkor.
- To determine if pharmacokinetic parameters necessitate changes in amikacin dosing for this specific pediatric group.
Main Methods:
- Intravenous amikacin was administered as a bolus dose (mean 5.5 mg/kg) to children aged 1-4 years.
- Key pharmacokinetic parameters including volume of distribution, elimination half-life, and clearance were analyzed.
- Data were compared against established reference values for healthy adults.
Main Results:
- The average volume of distribution showed a tendency towards the upper limit of normal.
- Plasma elimination half-life and clearance remained comparable to adult reference values.
- No significant renal impairment affecting amikacin clearance was observed despite slight increases in half-life.
Conclusions:
- Observed pharmacokinetic changes in kwashiorkor are not substantial enough to warrant altering current amikacin therapeutic regimens.
- Current dosing strategies for intravenous amikacin appear appropriate for pediatric patients with kwashiorkor.
- Further research may refine understanding, but immediate regimen changes are not indicated.
Abstract:
The pharmacokinetics of intravenous amikacin, administered as a mean (SD) bolus dose of 5.5 (1.2) mg/kg to children between the ages of 1 and 4 years with kwashiorkor, was studied. Although there was a tendency for the average volume of distribution to increase to the upper limit of normal, plasma elimination half-life, first order elimination-phase rate constant and clearance remained close to the reference values for adults. Despite marginal elevation of the average t1/2 beta-value, reflecting a general trend, renal impairment in respect of amikacin clearance could not be demonstrated. It was concluded that the changes in pharmacokinetic parameters found in kwashiorkor are not large enough to amend the current therapeutic regimens for amikacin in this condition.