부산대학교 도서관

Objectives This study aimed to assess the incidence of amikacin plasma peak concentration (C.sub.max) below 60 mg·L.sup.-1 in critically ill children receiving an amikacin dosing regimen of 30 mg kg.sup.-1·day.sup.-1. Secondary objectives were to identify factors associated with low C.sub.max and to assess the incidence of acute kidney injury (AKI). Methods A retrospective observational study was performed in two French pediatric intensive care units. All admitted children who received 30 mg·kg.sup.-1 amikacin and had a C.sub.max measurement were eligible. Clinical and biological data, amikacin dose, and concentrations were collected. Results In total, 30 patients were included, aged from 3 weeks to 7 years. They received a median amikacin dosage of 30 mg kg.sup.-1·day.sup.-1 (range 29-33) based on admission body weight (BW), corresponding to 27 mg kg.sup.-1·day.sup.-1 (range 24-30) based on actual BW. C.sub.max was < 60 mg·L.sup.-1 in 21 (70%) children and none had a C.sub.max [greater than or equal to] 80 mg·L.sup.-1. Among the 15 patients with a measured minimum inhibitory concentration (MIC), 13 (87%) had a C.sub.max/MIC ratio > 8. Univariate analysis showed that factors associated with C.sub.max < 60 mg·L.sup.-1 were high estimated glomerular filtration rate (p = 0.015) and low blood urea concentration (p = 0.001). AKI progression or occurrence was observed after amikacin administration in two (7%) and six (21%) patients, respectively. Conclusions Despite the administration of the maximal recommended amikacin dose, C.sub.max was below the pharmacokinetic target in 70% of our pediatric population. Further studies are needed to develop a pharmacokinetic model in a population of critically ill children to optimize target attainment.
Author(s): Rym Medjebeur Hanna [sup.1] , Michael Levy [sup.2] , Emmanuelle Bille [sup.3] , Carole Hennequin [sup.4] , Fabrice Lesage [sup.1] , Jérôme Naudin [sup.2] , Florence Moulin [sup.1] , [...]