Clinical audit of gentamicin use by Bayesian pharmacokinetic approach in critically ill children.

Introduction: Critically ill children tend to have altered gentamicin pharmacokinetics (PK); and so we carried out an audit of gentamicin use using the estimated peak concentrations (C _max ), trough concentrations (C _min ) and area-under-the-concentration-time curve (AUCs) by Bayesian approach.
Methods: Critically ill children with at least one serum gentamicin concentrations available were recruited. We used multiple models Bayesian adaptive control to estimate C _max , and AUC _0-t following each dose. Pediatric risk, injury, failure, loss, end stage renal disease (pRIFLE) criteria was used to identify the incidence of acute kidney injury (AKI).
Results: Seventy-three children (961 doses and 143 concentrations) were analysed. AUC _0-24 was observed to be higher in earlier age groups with a steady decline in older children. Similar changes were observed in C _max , C _min and AUC _0-24  at steady state. Significantly higher proportions of children in the other age groups were estimated to have C _max between 5 and 10 mg/L compared to neonates. Neonates had a higher risk of C _max above 10 mg/L. Patients with augmented renal clearance exhibited lower AUC _0-24 and reduced proportion achieving the target AUC _0-24 levels. Nearly one-third of children were observed to meet the pRIFLE criteria for AKI.
Conclusion: We observed higher initial doses and peak concentrations of gentamicin in neonates and infants compared to older age groups in critically ill children. Uniformity in the paediatric-specific standard treatment guidelines for gentamicin is the need of the hour.
Competing Interests: Declaration of Competing Interest Authors do not have any conflict of interest.
(Copyright © 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)