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Aminoglycoside administration in paediatrics: a literature search comparing international practices of intravenous injection or intravenous infusion
  1. Abigail Manning,
  2. Anna Burgess
  1. Welsh Medicines Advice Service, Cardiff and Vale University Health Board, Cardiff, South Glamorgan, UK
  1. Correspondence to Abigail Manning, Welsh Medicines Advice Service, Cardiff and Vale University Health Board, Cardiff, South Glamorgan, UK; Abigail.Manning{at}wales.nhs.uk

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Key messages

  • The suggested methods of aminoglycoside administration in paediatrics vary within the UK and internationally; however, there is more experience with intravenous infusion administration of aminoglycosides than for intravenous injection.

  • There is no definitive guidance available suggesting what method of administration is most appropriate for gentamicin, amikacin or tobramycin in paediatric patients.

  • Further studies are required to compare administration via intravenous injection and intravenous infusion, as well as pharmacodynamics changes, for example, the effects on time above the minimum inhibitory concentration when giving aminoglycosides via intravenous injection and how this affects both the clinical outcome and the incidence of adverse effects.

  • There are multiple small studies/case reports highlighting the efficacy and safety of giving gentamicin one time per day via intravenous injection. Further research regarding the cost-saving and time-saving benefits would further the discussion and help to clarify optimal practice.

Introduction

Aminoglycosides are a class of broad-spectrum, bactericidal antibiotics of which amikacin, gentamicin and tobramycin are the most commonly prescribed. These antibiotics are frequently prescribed for children, usually for infections, which are caused by aerobic Gram-negative pathogens. 1

Aminoglycosides are very poorly absorbed from the gastrointestinal tract, due to their lack of lipophilicity. Therefore, they must be administered parenterally. They are also concentration dependent, which means that the ratio between the peak concentrations (Cmax) to the pathogen’s minimum inhibitory concentration (MIC) is the pharmacokinetic-pharmacodynamic index, which is a marker for antimicrobial activity and effectiveness. To achieve an effective clinical response, a Cmax/MIC ratio between 8 and 12 has been advised, although this is based on adult data.1 Aminoglycosides have a narrow therapeutic margin, so therapeutic drug monitoring must be used to monitor for toxicity. High serum levels may result in ototoxicity and nephrotoxicity.1

Aminoglycosides are administered as once-daily or multiple-daily (previously known as ‘standard dose’) regimes. Once-daily …

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Footnotes

  • Contributors AM is the main author of the Medicines Update. Contributions include writing the article, research, creation of figures and tables included. AB contributed to the paper by reviewing AM’s work and undertaking initial research within the area.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.