Shankar S M, Jew R K, Bickert B M, Cavalieri G E, Bell L M, Lange B J
Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA.
J Pediatr Hematol Oncol. 1999 Jul-Aug;21(4):284-8. doi: 10.1097/00043426-199907000-00008.
To study the pharmacokinetics of single daily dose (SDD) gentamicin in children with cancer.
Serum concentrations of gentamicin were prospectively measured at 0.5, 8, 16, and 24 hours after a single daily dose of gentamicin 6 mg/kg, given as a 30-minute infusion in 18 febrile children with cancer and a central venous catheter. Then the peak (0.5-hour) and 12-hour serum concentrations of gentamicin were prospectively measured after a SDD of 7 mg/kg during 73 febrile episodes in 54 pediatric cancer patients with suspected infections. The aim was to achieve a peak serum concentration of 15 to 20 microg/mL 10 times the minimum inhibitory concentration (MIC) for sensitive Pseudomonas strains, resulting in good bactericidal activity and a long post-antibiotic effect (PAE) after a SDD of gentamicin.
The mean serum peak gentamicin concentration 30 minutes after the end of the infusion of 6 mg/kg was 13.3 +/- 4.0 microg/mL. The mean serum concentration 16 hours after the infusion was 0.3 +/- 0.2 microg/mL. The mean peak and 12-hour serum concentration after SDD of 7 mg/kg was 17.2 +/- 3.9 microg/mL and 0.9 +/- 0.7 microg/mL, respectively. The mean peak serum concentration after SDD of 7 mg/kg in children younger than 5 years of age (16.1 +/- 3.5 microg/mL ) was significantly lower than that of children over 5 years of age (18.2 +/- 3.9 microg/mL; P = 0.02). The desired peak serum concentration was achieved in 67% of children younger and 84% of those older than 5 years of age.
Adequate peak serum concentrations of gentamicin in children may be obtained with a SDD of 7 mg/kg. Children younger than 5 years of age achieve lower peak serum gentamicin concentration after SDD of 7 mg/kg than those older than 5 years.
研究每日单次剂量（SDD）庆大霉素在癌症患儿中的药代动力学。
对18例患有癌症且有中心静脉导管的发热患儿，在给予单次剂量6mg/kg庆大霉素并输注30分钟后，分别于0.5、8、16和24小时前瞻性地测定血清庆大霉素浓度。然后，在54例疑似感染的儿科癌症患者的73次发热发作期间，给予7mg/kg的SDD后，前瞻性地测定庆大霉素的峰值（0.5小时）和12小时血清浓度。目的是使血清峰值浓度达到15至20μg/mL，即敏感假单胞菌菌株最低抑菌浓度（MIC）的10倍，从而在庆大霉素单次给药后产生良好的杀菌活性和较长的抗生素后效应（PAE）。
输注6mg/kg结束后30分钟，血清庆大霉素平均峰值浓度为13.3±4.0μg/mL。输注后16小时的平均血清浓度为0.3±0.2μg/mL。7mg/kg的SDD后，平均峰值和12小时血清浓度分别为17.2±3.9μg/mL和0.9±0.7μg/mL。5岁以下儿童7mg/kg的SDD后平均血清峰值浓度（16.1±3.5μg/mL）显著低于5岁以上儿童（18.2±3.9μg/mL；P = 0.02）。5岁以下儿童中有67%、5岁以上儿童中有84%达到了所需的血清峰值浓度。
7mg/kg的SDD可使儿童获得足够的血清庆大霉素峰值浓度。5岁以下儿童在7mg/kg的SDD后血清庆大霉素峰值浓度低于5岁以上儿童。
