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Kale-Pradhan PB, Habowski SR, Chase HC, Castronova FC. Once-Daily Aminoglycosides: A Meta-Analysis of Nonneutropenic and Neutropenic Adults. J Pharm Technol 2016. [DOI: 10.1177/875512259801400109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To compare the efficacy, nephrotoxicity, and ototoxicity of once-daily dosing of aminoglycosides versus conventional dosing. Design: Meta-analysis of 14 randomized trials identified through a MEDLINE search (January 1965-May 1996). Patients: Neutropenic and nonneutropenic adults. Interventions: Patients were randomly selected to receive an aminoglycoside once daily or in multiple daily doses. Measurements and Main Outcomes: The outcomes considered were clinical cure, bacteriologic cure, nephrotoxicity, auditory toxicity, and vestibular toxicity. The data were analyzed in the following subgroups: (1) all trials, (2) nonneutropenic patients, (3) neutropenic patients, and (4) patients with undefined neutrophil status. For all trials the pooled risk ratio was 1.268 (95% CI 0.828 to 1.939) for clinical cure, and was 1.390 (95% CI 1.350 to 1.392) for bacteriologic cure. Nephrotoxicity had a pooled risk ratio of 0.765 (95% CI 0.468 to 1.252), that for auditory toxicity was 1.117 (95% CI 0.151 to 5.636), and that for vestibular toxicity was 1.155 (95% CI 0.221 to 6.039). Analysis of the subgroups, including a separate analysis of neutropenic patients, demonstrated similar results. Conclusions: When all trials were considered, once-daily administration of aminoglycosides had similar efficacy and no increase in nephrotoxicity or ototoxicity compared with conventional aminoglycoside dosing.
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Lortholary O, Lefort A, Tod M, Chomat AM, Darras-Joly C, Cordonnier C. Pharmacodynamics and pharmacokinetics of antibacterial drugs in the management of febrile neutropenia. THE LANCET. INFECTIOUS DISEASES 2008; 8:612-20. [DOI: 10.1016/s1473-3099(08)70228-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Dupuis LL, Sung L, Taylor T, Abdolell M, Allen U, Doyle J, Taddio A. Tobramycin Pharmacokinetics in Children with Febrile Neutropenia Undergoing Stem Cell Transplantation: Once-Daily versus Thrice-Daily Administration. Pharmacotherapy 2004; 24:564-73. [PMID: 15162890 DOI: 10.1592/phco.24.6.564.34743] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To describe the pharmacokinetic disposition of tobramycin in children undergoing stem cell transplantation (SCT) after intravenous administration either every 24 hours or every 8 hours, and to use this information to create initial dosing guidelines for administration every 24 hours in this patient population. DESIGN Pharmacokinetic analysis of a randomized controlled trial. SETTING The Hospital for Sick Children, Toronto, Ontario, Canada. PATIENTS Sixty children (< 18 yrs) with febrile neutropenia undergoing stem cell transplantation. INTERVENTION Patients were randomized to receive intravenous tobramycin either every 24 hours (29 patients) or every 8 hours (31 patients). Initially, they received either 2.5 mg/kg/dose every 8 hours or weight-based doses by age group (< 5 yrs, 9 mg/kg/dose; 5 to < 12 yrs, 8 mg/kg/dose; > or = 12 yrs, 7 mg/kg/dose) every 24 hours. MEASUREMENTS AND MAIN RESULTS Serum tobramycin concentrations were obtained at 2 and 8 hours after the first dose. Initial guidelines for dosing every 24 hours were derived using the parameters from all patients to achieve a maximum serum concentration (Cmax) of 20-22.5 mg/L and a drug-free interval (time during dosing interval when the tobramycin concentration was < 1 mg/L) of at least 4 hours. After the first tobramycin dose, the elimination rate constant (kel) and volume of distribution (Vd) observed in the every-8-hour group (23 patients) were 0.34 +/- 0.09 hours(-1) and 0.48 +/- 0.21 L/kg, respectively. The kel and Vd in the every-24-hour group (22 patients) were 0.43 +/- 0.12 hr(-1) and 0.43 +/- 0.26 L/kg, respectively. Tobramycin Vd varied with age. Initial doses of tobramycin every 24 hours recommended to achieve the target parameters are 10 mg/kg/dose for patients aged 6 months to less than 9 years, 8 mg/kg/dose for those aged 9 to less than 12 years, and 6 mg/kg/dose for those aged 12 years or older. CONCLUSION Children undergoing SCT who receive tobramycin every 24 hours should receive an initial dose based on age. Further validation of the proposed dosing guidelines is required.
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Affiliation(s)
- L Lee Dupuis
- Department of Pharmacy, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Knoderer CA, Everett JA, Buss WF. Clinical issues surrounding once-daily aminoglycoside dosing in children. Pharmacotherapy 2003; 23:44-56. [PMID: 12523459 DOI: 10.1592/phco.23.1.44.31924] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aminoglycoside antibiotics are first-line treatment for many infectious diseases in the pediatric population and are effective in adults. The traditional dosing interval in children is every 8-12 hours. Studies in adults reported equivalent efficacy and equal or less toxicity with once-daily regimens. Despite many studies in the adult population, this approach has yet to become standard practice in most pediatric hospitals. Reasons for lack of acceptance of this strategy in children include rapid aminoglycoside clearance, unknown duration of postantibiotic effect, safety concerns, and limited clinical and efficacy data.
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Affiliation(s)
- Chad A Knoderer
- Department of Pharmacy Services, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46202, USA.
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Kraus DM, Pai MP, Rodvold KA. Efficacy and tolerability of extended-interval aminoglycoside administration in pediatric patients. Paediatr Drugs 2003; 4:469-84. [PMID: 12083974 DOI: 10.2165/00128072-200204070-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Aminoglycosides are commonly used to treat serious Gram-negative infections in pediatric patients. An effort to improve the efficacy and tolerability of this antibiotic class has led to evaluation of extended-interval aminoglycoside administration (EIAA). EIAA is designed to achieve higher peak plasma aminoglycoside concentrations, with relatively undetectable trough concentrations, when compared with conventional aminoglycoside administration (CAA), and is therefore expected to be markedly effective and to reduce drug accumulation and prevent nephrotoxicity and ototoxicity. Clinical trials evaluating EIAA in neonates included patients with suspected Gram-negative infections requiring short courses of aminoglycoside therapy. Consequently, comparative efficacy of EIAA versus CAA could not be assessed. In addition, ototoxicity was often not assessed, and nephrotoxicity was virtually undetectable. Similarly, trials evaluating EIAA versus CAA in infants and children have not demonstrated a difference in outcomes. The use of EIAA in children with febrile neutropenia has been evaluated primarily with amikacin. The incidences of nephrotoxicity and ototoxicity were low, and were similar between EIAA and CAA. No deaths were reported in any of these studies; however, this could be related to the inclusion of patients with undocumented bacteremia. Further investigation of EIAA is necessary in patients with documented bacteremia, since plasma aminoglycoside concentrations were undetectable for most of the dosage interval in children with febrile neutropenia who were treated once daily. Overall, clinical studies suggest that EIAA has similar efficacy to, and no higher risk of toxicity than, CAA in neonates, infants, and children. A few evaluations have also demonstrated that EIAA is cost-effective in neonates and in children with febrile neutropenia. Future studies evaluating the efficacy and tolerability of EIAA in pediatric patients with documented systemic infections should be prospective, randomized, controlled trials with sample sizes sufficient to detect differences between administration methods. Further evaluations should also address the optimal dosage and cost-effectiveness of EIAA in infants and children.
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Affiliation(s)
- Donna M Kraus
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, USA
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Jezowska-Bojczuk M, Szczepanik W, Leśniak W, Ciesiołka J, Wrzesiński J, Bal W. DNA and RNA damage by Cu(II)-amikacin complex. EUROPEAN JOURNAL OF BIOCHEMISTRY 2002; 269:5547-56. [PMID: 12423353 DOI: 10.1046/j.1432-1033.2002.03260.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The oxidation-promoting reactivity of copper(II) complex of aminoglycosidic antibiotic amikacin [Cu(II)-Ami] in the presence of hydrogen peroxide, was studied at pH 7.4, using 2'-deoxyguanosine (dG), pBR322 plasmid DNA and yeast tRNAPhe as target molecules. The mixtures of complex with H2O2 were found to be efficient oxidants, converting dG to its 8-oxo derivative, generating strand breaks in plasmid DNA and multiple cleavages in tRNAPhe. The complex underwent autooxidation as well, with amikacin hydroperoxides as likely major products. This reactivity pattern was found to be due to a combination of metal-bound and free hydroxyl radicals.
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Affiliation(s)
- Małgorzata Jezowska-Bojczuk
- Faculty of Chemistry, University of Wrocław, Wrocław, Poland; Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznań, Poland.
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Abstract
The development of new and often more successful regimens of treatment for childhood blood and malignant diseases has usually been associated with a parallel increase in infectious problems. This is because these successes have often, in the absence of new effective drugs, been achieved by increasing drug dose intensity to new limits. This chapter is not intended to deal with every possible infection, but rather to be a practical guide to the current management of infection. The last few years have seen major improvements in the development of haematopoietic growth factors, new antifungal agents, new antibiotics and new ways to use aminoglycosides. Attempts are being made to identify good and poor risk factors for the outcome of infection in order to facilitate shorter courses and possibly home or day care use of antimicrobial agents. In addition the different needs of children are being recognized in view of the restricted use of quinolones in this group and the different organisms and types of infection that they experience.
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Affiliation(s)
- I M Hann
- Great Ormond Street Children's Hospital, London, UK
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Shankar SM, Jew RK, Bickert BM, Cavalieri GE, Bell LM, Lange BJ. Pharmacokinetics of single daily dose gentamicin in children with cancer. J Pediatr Hematol Oncol 1999; 21:284-8. [PMID: 10445890 DOI: 10.1097/00043426-199907000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the pharmacokinetics of single daily dose (SDD) gentamicin in children with cancer. METHODS Serum concentrations of gentamicin were prospectively measured at 0.5, 8, 16, and 24 hours after a single daily dose of gentamicin 6 mg/kg, given as a 30-minute infusion in 18 febrile children with cancer and a central venous catheter. Then the peak (0.5-hour) and 12-hour serum concentrations of gentamicin were prospectively measured after a SDD of 7 mg/kg during 73 febrile episodes in 54 pediatric cancer patients with suspected infections. The aim was to achieve a peak serum concentration of 15 to 20 microg/mL 10 times the minimum inhibitory concentration (MIC) for sensitive Pseudomonas strains, resulting in good bactericidal activity and a long post-antibiotic effect (PAE) after a SDD of gentamicin. RESULTS The mean serum peak gentamicin concentration 30 minutes after the end of the infusion of 6 mg/kg was 13.3 +/- 4.0 microg/mL. The mean serum concentration 16 hours after the infusion was 0.3 +/- 0.2 microg/mL. The mean peak and 12-hour serum concentration after SDD of 7 mg/kg was 17.2 +/- 3.9 microg/mL and 0.9 +/- 0.7 microg/mL, respectively. The mean peak serum concentration after SDD of 7 mg/kg in children younger than 5 years of age (16.1 +/- 3.5 microg/mL ) was significantly lower than that of children over 5 years of age (18.2 +/- 3.9 microg/mL; P = 0.02). The desired peak serum concentration was achieved in 67% of children younger and 84% of those older than 5 years of age. CONCLUSION Adequate peak serum concentrations of gentamicin in children may be obtained with a SDD of 7 mg/kg. Children younger than 5 years of age achieve lower peak serum gentamicin concentration after SDD of 7 mg/kg than those older than 5 years.
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Affiliation(s)
- S M Shankar
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA
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Logsdon BA, Phelps SJ. Routine monitoring of gentamicin serum concentrations in pediatric patients with normal renal function is unnecessary. Ann Pharmacother 1997; 31:1514-8. [PMID: 9416390 DOI: 10.1177/106002809703101212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Due to increasing demands for cost containment within the healthcare system, we evaluated the need for routine gentamicin concentrations (i.e., peak and trough with third dose). DESIGN Single-institution study performed concurrently with hospitalization. SETTING A 225-bed pediatric teaching hospital. PARTICIPANTS The study population consisted of 150 hospitalized pediatric patients (53% medicine, 47% surgical patients) from 3 months to 15 years old with normal serum creatinine. OUTCOME MEASURES If the administered dose produced diagnoses-appropriate peak concentrations of at least 4 micrograms/mL or 5 micrograms/mL in bacteremia/septicemia and at least 6 micrograms/mL or 8 micrograms/mL in patients with pneumonia if trough serum gentamicin concentrations were less than 2 micrograms/mL, if the patient was noted by the attending physician to be clinically responding as well as objectively having a decreased white blood cell count and was afebrile, and if there was not an increase of 0.5 mg/dL or more in serum creatinine during the course of therapy. RESULTS Patients received a mean dose of gentamicin 2.51 +/- 0.14 mg/kg i.v. q8h, which resulted in a mean peak concentration of 6.1 +/- 1.7 micrograms/mL (range 2.4-11.7) and a mean trough concentration of 0.5 +/- 0.3 microgram/mL (range 0.1-1.8). Peak and trough concentrations were at least 4 micrograms/mL and less than 2 micrograms/mL in 96% and 100% of patients, respectively. No patient required a dosage change due to lack of clinical response. CONCLUSIONS Our data do not support the routine monitoring of gentamicin concentrations in pediatric patients older than 3 months of age who are receiving appropriate standard doses of gentamicin and have normal renal function.
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Affiliation(s)
- B A Logsdon
- Cook Children's Medical Center, Fort Worth, TX 76104, USA
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Forsyth NB, Botha JH, Hadley GP. A comparison of two amikacin dosing regimens in paediatric surgical patients. ANNALS OF TROPICAL PAEDIATRICS 1997; 17:253-61. [PMID: 9425382 DOI: 10.1080/02724936.1997.11747896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This investigation aimed to compare the efficacy and toxicity of two amikacin dosing regimens in seriously ill paediatric surgical patients. Children (0.6-12 years old) received amikacin intravenously either once daily (15 mg/kg, n = 27) or twice daily (7.5 mg/kg, n = 27). Concomitant medication was given as prescribed. Mean (SD) peak serum amikacin levels were significantly different (p < 0.05) between the once and twice daily groups (37.7 (6.9) mg/l and 19.5 (3.7) mg/l, respectively). Cumulative dose and duration of therapy were also significantly higher in the once-daily group. Regimen efficacy (favourable, unfavourable or indeterminate outcome) was assessed by patient temperatures, clinical improvement and white cell counts. Serum creatinine measurements and post-therapy, pure tone air conduction audiometry assessed nephro- and ototoxicity, respectively. No statistically significant differences were found between the groups in terms of outcome (18/24 and 22/25 patients in the once- and twice-daily groups had favourable outcomes; there were no unfavourable outcomes), nephrotoxicity (none of the patients assessed developed nephrotoxicity) or ototoxicity (2/20 and 5/20 patients, respectively, had mild high frequency hearing deficits which were predominantly unilateral and reversible). Although the regimens were similar in this study, other investigations will further clarify the optimal dosing approach in paediatric patients.
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Affiliation(s)
- N B Forsyth
- Department of Experimental and Clinical Pharmacology, Faculty of Medicine, University of Natal, Durban, South Africa
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Bertrand Y, Bréant V, Vray C, Nakache C, Barbé G, Dürr F, Aulagner G. [Clinical, pharmacokinetic and therapeutic study of amikacin with single daily dose and in combination in neutropenic children with fever]. Arch Pediatr 1996; 3:854-60. [PMID: 8949344 DOI: 10.1016/0929-693x(96)87572-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The efficacy of single daily dose of amikacin has been recently demonstrated in neutropenic children with fever. POPULATION AND METHODS Eighteen children aged 1 to 15 years were included in the study. All patients were febrile and granulocytopenic and had indwelling intravenous catheter. Amikacin was administered as a 30-minute intravenous infusion once daily (20 mg/kg on day 1, then 15 mg/kg) for 3 to 30 days; the patients received amikacin in combination with piperacillin and vancomycin. Serum levels of amikacin were measured on days 1, 3, 6 and 10, and 30 min, 60 min and 180 min after the end of the infusion. RESULTS All patients responded favourably to the antibiotic therapy. Sixty-two kinetics were performed: peak amikacin concentrations measured (30 min after 30-min infusion) on day 1 averaged 43.7 micrograms/mL (+/- 13.8). A significant increase in peak serum concentrations was observed during the treatment (day 3 vs day 10) without change in the trough serum concentrations. The volumes of distribution were considerably important in these granulocytopenic children and there was a large inter and intra-patient variability; the elimination half-life of the amikacin was short (1.45 h). There was no significant nephrotoxicity in any patient. CONCLUSION The use of single daily dose amikacin in combination with a broad spectrum beta-lactam antibiotic and vancomycin was efficient and safe in febrile granulocytopenic children. The simulation of the amikacin behaviour in the deep compartment should be evaluated; in fact, it might reflect better accumulation of the drug than serum concentrations.
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Affiliation(s)
- Y Bertrand
- Service d'hématologie-immunologie pédiatrique et de transplantation de moelle osseuse, Institut Pasteur, France
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Belfayol L, Talon P, Eveillard M, Alet P, Fauvelle F. Pharmacokinetics of once-daily amikacin in pediatric patients. Clin Microbiol Infect 1996; 2:186-191. [PMID: 11866842 DOI: 10.1016/s1198-743x(14)65141-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE: To study the pharmacokinetic parameters of a once-daily regimen of amikacin (15 mg/kg) in association with other antimicrobial agents in 35 children with severe Gram-negative infections. METHODS: A Bayesian approach was developed to optimize the amikacin regimen. The predictive performance was assessed by computing bias and precision. Each patient was evaluated for toxicity after 5 days of treatment. RESULTS: Peak amikacin concentrations on days 2 and 5 of therapy averaged 31.3 plus minus 9.0 mg/L and 32.4 plus minus 7.4 mg/L, respectively. To achieve peak serum concentrations between 30 and 40 mg/L, individualized dosage was necessary in 19 of 35 children. The pharmacokinetic parameters showed large interindividual variations, with a mean half-life of 2 h and a mean volume of distribution of 0.36 L/kg. No nephrotoxicity was observed in any of the children. After individualization of dosage on the basis of one measurement of peak concentration, no significant differences were observed between predicted and subsequently measured amikacin concentrations. CONCLUSIONS: Once-daily dosage of amikacin (15 mg/kg) is well tolerated in pediatric patients; however, a loading dose of 20 mg/kg is recommended to achieve a therapeutic peak value between 30 and 40 mg/L. Initial serum monitoring is essential in a population such as children, with wide interpatient variability. Using the Bayesian approach, the amikacin regimen in children can then be predicted with minimal bias and good precision.
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Osoba AO. Efficacy and safety of a single daily dose of aminoglycoside therapy. Ann Saudi Med 1995; 15:543-4. [PMID: 17589004 DOI: 10.5144/0256-4947.1995.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A O Osoba
- Consultant Microbiologist, Department of Pathology, Armed Forces Hospital, Riyadh, Saudi Arabia
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Abstract
OBJECTIVE To provide an overview of the efficacy and adverse effects associated with once-daily administration of aminoglycosides. DATA SOURCES An extensive MEDLINE search and review of journals was conducted to identify information for this review. DATA SYNTHESIS Aminoglycosides alone or in combination with beta-lactams are commonly used for their activity against gram-negative microorganisms. Numerous studies have been performed comparing efficacy and toxicity of once-daily administration of aminoglycosides with multiple-daily dosing. Two studies have found a significant difference in clinical efficacy between once-daily and multiple-daily dosing of aminoglycosides. Several studies have observed a lower incidence of toxicity with once-daily than multiple-daily dosing, but others have found no difference. CONCLUSIONS Review of the literature suggests that once-daily administration of aminoglycosides may be as safe and effective as multiple-daily dosing regimens for the treatment of certain infections caused by gram-negative bacteria.
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Affiliation(s)
- R D Bates
- Ohio State University, Wexner Institute for Pediatric Research, Columbus
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Bouffet E, Fuhrmann C, Frappaz D, Couillioud D, Artiges V, Charra C, Bouhour D, Brunat Mentigny M. Once daily antibiotic regimen in paediatric oncology. Arch Dis Child 1994; 70:484-7. [PMID: 8048816 PMCID: PMC1029865 DOI: 10.1136/adc.70.6.484] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The feasibility and efficacy of a once daily antibiotic regimen were assessed in children with malignant tumours. Over a 44 month period, 296 febrile episodes were treated with a regimen of once daily ceftriaxone-amikacin (and teicoplanin or vancomycin if the patient had a central line). The treatment was successful in 272 (92%) episodes without modification of the antibiotic regimen, and only one patient died of uncontrolled sepsis. A once daily antibiotic regimen is therefore feasible and worthwhile in the treatment of febrile episodes in children with cancer.
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Affiliation(s)
- E Bouffet
- Paediatric Department, Centre L. Bérard, Lyon, France
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Petitjean O, Prevot M, Lortholary O, Tod M, Nicolas P. Pharmacocinétique comparée des aminosides utilisés en dose unique journalière. Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)80981-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Etude clinique, bactériologique et pharmacocinétique de l'amikacine en dose unique journalière en oncologie pédiatrique. Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)80985-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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