Amikacin pharmacokinetics to optimize dosing in neonates with perinatal asphyxia treated with hypothermia

Sinziana Cristea, Anne Smits, Aida Kulo, Catherijne A.J. Knibbe, Mirjam Van Weissenbruch, Elke H.J. Krekels, Karel Allegaert*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Aminoglycoside pharmacokinetics (PK) is expected to change in neonates with perinatal asphyxia treated with therapeutic hypothermia (PATH). Several amikacin dosing guidelines have been proposed for treating neonates with (suspected) septicemia; however, none provide adjustments for cases of PATH. Therefore, we aimed to quantify the differences in amikacin PK between neonates with and without PATH to propose suitable dosing recommendations. Based on amikacin therapeutic drug monitoring data collected retrospectively from neonates with PATH, combined with a published data set, we assessed the impact of PATH on amikacin PK by using population modeling. Monte Carlo and stochastic simulations were performed to establish amikacin exposures in neonates with PATH after dosing according to the current guidelines and according to proposed model-derived dosing guidelines. Amikacin clearance was decreased 40.6% in neonates with PATH, with no changes in volume of distribution. Simulations showed that increasing the dosing interval by 12 h results in a decrease in the percentage of neonates reaching toxic trough levels (5 mg/liter), from 40 to 76% to 14 to 25%, while still reaching efficacy targets compared to the results of current dosing regimens. Based on this study, a 12-h increase in the amikacin dosing interval in neonates with PATH is proposed to correct for the reduced clearance, yielding safe and effective exposures. As amikacin is renally excreted, further studies into other renally excreted drugs may be required, as their clearance may also be impaired.

Original languageEnglish
Article numbere01282
JournalAntimicrobial Agents and Chemotherapy
Volume61
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017

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