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[Amikacin in single daily doses in children with fever]
F Solórzano-Santos1, M G Miranda-Novales, R Díaz-Peña
1Departamento de Infectología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Mexico, D.F.
Insights
Once-daily amikacin (aminoglycoside) dosing is as effective as thrice-daily dosing for children with cancer, fever, and neutropenia. This dosing strategy shows comparable efficacy and does not increase toxicity.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Pharmacology
Background:
- Fever and neutropenia are common complications in children undergoing cancer treatment.
- Prompt and effective antibiotic therapy is crucial for managing febrile neutropenia in pediatric cancer patients.
Purpose of the Study:
- To compare the efficacy and safety of once-daily versus thrice-daily amikacin dosing in combination with carbenicillin for treating febrile neutropenia in children with cancer.
Main Methods:
- A randomized clinical trial involving 50 pediatric cancer patients with fever and neutropenia.
- Patients were assigned to receive either once-daily or thrice-daily amikacin, both in combination with carbenicillin.
- Efficacy endpoints included time to fever resolution and clinical improvement; safety was assessed by monitoring serum creatinine levels.
Main Results:
- No significant intergroup differences were observed in the median time to fever resolution (6 days vs. 7 days) or clinical improvement (6 days vs. 7 days).
- Peak amikacin levels varied between groups, but serum creatinine levels remained within normal ranges, indicating no significant increase in nephrotoxicity.
- A small number of deaths occurred in both groups, with no clear association with the dosing regimen.
Conclusions:
- Once-daily administration of amikacin appears to be as effective and safe as the traditional thrice-daily dosing for pediatric cancer patients with febrile neutropenia.
- This simplified dosing regimen may offer a more convenient alternative for treating this patient population.
Abstract:
A randomized clinical trial was performed in children with cancer, fever and neutropenia, to evaluate the efficacy of amikacin once daily versus thrice daily dosing plus carbenicillin in both groups. Fifty patients were included, 25 patients in group A who received amikacin once daily and 25 in group B who received amikacin thrice daily. No intergroup differences were observed, i.e., fever diminished in a median of 6 days (2-8 days) vs. 7 days (3-12 days) in groups A and B respectively (p = 0.37);clinical improvement was observed in a median of 6 days (3-10 days) vs 7 days (2-14 days) (p = 0.68). One patient in group A and two in B died. The peak levels of amikacin on the 7th day of treatment were 10-60 and 7-25 micrograms/mL in groups A and B respectively, and the serum creatinine levels were 0.3 - 0.7 for group A and 0.2 - 0.8 mg/dL for group B; none of the patients presented a creatinine above 40% of the basal value. Three patients of group A had amikacin levels higher than 40 micrograms/mL without increasing the creatinine levels; our observations do not suggest that toxicity is higher. We conclude that the administration of aminoglycoside once daily seems to be as effective as the traditional dosing.
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