Clinical audit of gentamicin use by Bayesian pharmacokinetic approach in critically ill children.

INTRODUCTION

Critically ill children tend to have altered gentamicin pharmacokinetics (PK); and so we carried out an audit of gentamicin use using the estimated peak concentrations (C), trough concentrations (C) and area-under-the-concentration-time curve (AUCs) by Bayesian approach.

METHODS

Critically ill children with at least one serum gentamicin concentrations available were recruited. We used multiple models Bayesian adaptive control to estimate C, and AUC following each dose. Pediatric risk, injury, failure, loss, end stage renal disease (pRIFLE) criteria was used to identify the incidence of acute kidney injury (AKI).

RESULTS

Seventy-three children (961 doses and 143 concentrations) were analysed. AUC was observed to be higher in earlier age groups with a steady decline in older children. Similar changes were observed in C, C and AUC at steady state. Significantly higher proportions of children in the other age groups were estimated to have C between 5 and 10 mg/L compared to neonates. Neonates had a higher risk of C above 10 mg/L. Patients with augmented renal clearance exhibited lower AUC and reduced proportion achieving the target AUC levels. Nearly one-third of children were observed to meet the pRIFLE criteria for AKI.

CONCLUSION

We observed higher initial doses and peak concentrations of gentamicin in neonates and infants compared to older age groups in critically ill children. Uniformity in the paediatric-specific standard treatment guidelines for gentamicin is the need of the hour.