A prospective study of long-term use of amikacin in a paediatrics department. Indications, administration, side-effects, bacterial isolates and resistance.

Amikacin (Amikin; B-M) was used as the only aminoglycoside for 18 months in a paediatric department within a general hospital because of high levels of resistance of Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterobacter cloacae isolates to tobramycin, gentamicin and netilmicin. Between 1 February 1987 and 31 July 1988, 816 children were treated with a slow intravenous injection at a standardised dose adjusted for weight and age. Respiratory disease was present in 35.8% of 537 neonates, 56.4% of 190 infants and 70.9% of 89 older children. Escherichia coli (65 isolates), Klebsiella species (59 isolates), Enterobacter species (26 isolates) and P. aeruginosa (22 isolates) constituted the most common Gram-negative pathogens. The positive blood culture yield was 7.8%. Satisfactory median peak and trough serum amikacin levels were achieved. No significant renal side-effects were noted. Severe bilateral hearing loss in 1 low-birthweight infant resulted from inadvertent overdosage. At the end of this 18-month surveillance period 97.7% of E. coli, 98.6% of K. pneumoniae, 96.3% of E. cloacae, and 98.0% of P. aeruginosa isolates remained sensitive to amikacin, while resistance of K. pneumoniae to tobramycin, netilmicin and gentamicin decreased significantly (P less than 0.003, P less than 0.001 and P less than 0.007 respectively; chi-square test).