Abstract
Twenty cystic fibrosis patients aged 1.8–22 years (mean ±SD: 9.6 ± 4.8 years) withPseudomonas aeruginosa pulmonary exacerbations were treated with amikacin (AM) (35 mg/kg/day in one daily 30 min infusion) associated with either ceftazidime (200 mg/kg/day in 3 i.v. injections) (n = 19) or imipenem (n = 1) at the same dose. Glomerular and tubular functions (creatinine clearance, 24-h proteinuria, β2 microglobulinuria, lysozymuria) and audiometry remained within normal ranges from day 0 to day 14. A peak concentration of AM of 83 ± 19 mg/l and a trough concentration of 0.8 ±0.5 mg/l were observed in blood while AM levels in sputum were above the minimal inhibitory concentration 50 from 30 min to 16 h. No serum accumulation of AM was observed during the treatment. From day 0 to day 14, the following changes were observed: weight/height ratio: 96%–100% (P < 0.001); daily energy intake: 111%–128% of RDA (P < 0.001); prealbumin: 195–290 mg/l (P < 0.001); forced vital capacity (FVC): 66%–81% (P < 0.01); forced expiratory volume in 1 s: 60%–75% (P < 0.01); forced expiratory flow between 25% and 75% of FVC: 42%–56% (P < 0.01); nocturnal SaO2 also improved significantly; cardiac rate decreased from 89 ±18/min to 76 ± 16/min (P < 0.001); respiratory rate decreased from 31 ±15/min to 26 ± 10/min (P < 0.05); inflammatory parameters (white blood cells, polymorphonuclear cells, erythrocyte sedimentation rate) also improved.
Similar content being viewed by others
Abbreviations
- AM :
-
amikacin
- CF :
-
cystic fibrosis
- FVC :
-
forced vital capacity
- M30 :
-
30 min
- MIC :
-
minimal inhibitory concentration
- PA :
-
Pseudomonas aeruginosa
References
Allen MB, Mellon AF, Simmonds EJ, Page RL, Littlewood JM (1993) Changes in nocturnal oximetry after treatment of exacerbations in cystic fibrosis. Arch Dis Child 69: 197–201
Autret E, Marchand S, Breteau M, Grenier B (1986) Pharmacokinetics of amikacin in cystic fibrosis: a study of bronchial diffusion. Eur J Clin Pharmacol 31:79–83
Braggion C, Pradal U, Mastella G (1992) Hemoglobin desaturation during sleep and daytime in patients with cystic fibrosis and severe airway obstruction. Acta Pædiatr 81:1002–1006
Byl B, Baran D, Herchuelz A, Roucloux I, Lambert C, Van der Auwera P, Thys JP (1992) Sputum penetration of a single daily dose of amikacin and a continuous infusion of ceftazidime in cystic fibrosis patients. 32nd ICAAC (Anaheim); Abstract 209
Gilbert DN (1991) Once-daily aminoglycoside therapy. Antimicrob Agents Chemother 35:399–405
Gnansounou M, Nelken B, Vic P, Husson MO, Mazingue F, Lambilliotte A, Farriaux JP (1995) Pharmacokinetics of once-daily teicoplanin, amikacin, ceftriaxone and continuous infusion of vancomycin, ceftazidime plus once-daily amikacin in febrile neutropenic children. International Society of Paediatric Oncology. XXVIIth meeting, Montevideo, October 10–14. Med Pediatr Oncol 4: 288 (abstract P-38)
Levy J, Baran D, Klastersky J (1982) Comparative study of the anti-bacterial activity of amikacin and tobramycin during Pseudomonas pulmonary infection in patients with cystic fibrosis. J Antimicrob Chemother 10: 227–234
Moore RD, Lietman PS, Smith CR (1987) Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimal inhibitory concentration. J Infect Dis 155:93–99
Neijens HJ (1989) Strategies and perspectives in treatment of respiratory infections. Acta Pædiatr Scand [Suppl] 363:66–73
Nelson J (1985) Management of acute pulmonary exacerbations in cystic fibrosis: a critical appraisal. J Pediatr 106:1030–1033
Nilsson L, Sören L, Rädberg G (1987) Frequencies of variants resistant to different aminoglycosides in Pseudomonas aeruginosa. J Antimicrob Chemother 20:255–259
Prandota J (1987) Drug disposition in cystic fibrosis: progress in understanding pathophysiology and pharmacokinetics. Pediatr Infect Dis 6: 1111–1126
Sempé M, Pedron G, Roy-Pernot MF (1979) Auxologie. Méthodes et séquences. Théraplix
Smith AL (1986) Antibiotic therapy in cystic fibrosis: evaluation of clinical trials. J Pediatr 108:866–870
Smith AL, Ramsey B, Redding G, Haas J (1989) Endobronchial infection in cystic fibrosis. Acta Paediatr Scand [Suppl] 363:31–36
Szaff M, Hoiby N, Flensborg W (1983) Frequent antibiotic therapy improves survival of cystic fibrosis patients with chronic Pseudomonas aeruginosa infection. Acta Paediatr Scand 72: 651–657
Van der Auwera P (1991) Pharmacokinetic evaluation of single daily dose amikacin. J Antimicrob Chemother 27 [Suppl C]:63–71
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vic, P., Ategbo, S., Turck, D. et al. Tolerance, pharmacokinetics and efficacy of once daily amikacin for treatment of Pseudomonas aeruginosa pulmonary exacerbations in cystic fibrosis patients. Eur J Pediatr 155, 948–953 (1996). https://doi.org/10.1007/BF02282885
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02282885