Therapeutic monitoring of amikacin regimen-associated toxicity in febrile neutropenic pediatric cancer patients

Abstract EN

Background Amikacin is used in the treatment of fever neutropenia (FN) in pediatric cancer patients.

However it may be used once or twice daily, so the explanation of which regimen of amikacin (once or twice) is more effective and less toxic and how to detect renal toxicity early may help in a proper treatment of febrile neutropenia.

Aim This study aimed to compare between once-daily versus twice-daily regimens of amikacin to know which regimen is most effective and less toxic.

Patients and methods Venous blood from 40 pediatric patients with FN receiving 15 mg/kg amikacin intravenously either once a day (group I) or divided into two equal doses (group II) every 12 h by 30 min infusion.

Amikacin was measured by means of homogeneous enzyme immunoassay for all patients.

Renal function was assessed by measuring serum creatinine before and after the treatment.

Results There were higher significant differences between once‑daily versus twice‑daily regimens of amikacin in the treatment of FN.

The peak levels of amikacin were significantly higher in group I than those in group II (P = 0.001) and the duration of fever in group I was less than that in group II.

Conclusion Therapeutic drug monitoring of amikacin should be done to detect its renal toxicity early and the administration of amikacin as a single daily dose may be associated with greater efficacy and less nephrotoxicity compared with that of amikacin administered as twice-daily dose.