scholarly journals 1406. Augmented Renal Clearance Using Aminoglycoside Population-Based Pharmacokinetic Modeling with Bayesian Estimation in Children in the Pediatric Intensive Care Unit

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S433-S433
Author(s):  
Sean Avedissian ◽  
Nathaniel Rhodes ◽  
Yuna Kim ◽  
Josh Valdez ◽  
John Bradley ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bayesian Estimation ◽  
Renal Clearance ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Population Based ◽  
Pharmacokinetic Modeling ◽  
Augmented Renal Clearance

1430: AUGMENTED RENAL CLEARANCE IN THE PEDIATRIC INTENSIVE CARE UNIT

2020 ◽  
Vol 48 (1) ◽  
pp. 692-692
Author(s):  
Jeffrey Cies ◽  
Nicole Betancourt ◽  
Amir Bar ◽  
Wayne Moore ◽  
Arun Chopra
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Clearance ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Augmented Renal Clearance

AUGMENTED RENAL CLEARANCE IMPLIES A NEED FOR INCREASED AMOXICILLIN-CLAVULANATE DOSING IN CRITICALLY ILL CHILDREN

2015 ◽  
Vol 101 (1) ◽  
pp. e1.15-e1
Author(s):  
Pieter De Cock ◽  
Joseph Standing ◽  
Charlotte Barker ◽  
Annick de Jaeger ◽  
Mieke Carlier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Renal Function ◽  
Intensive Care ◽  
Renal Clearance ◽  
Pediatric Intensive Care ◽  
Compartment Model ◽  
Critically Ill Children ◽  
Augmented Renal Clearance ◽  
Blood Samples ◽  
Amoxicillin Clavulanate

BackgroundAmoxicillin/clavulanate is commonly used to treat community-acquired infections on the pediatric intensive care unit. Few data are available to guide dosing in this vulnerable population.MethodsThis prospective pharmacokinetic study enrolled patients admitted to the pediatric intensive care unit in whom intravenous amoxicillin-clavulanate was indicated (25–35 mg/kg q6h). Serial blood samples were obtained following the first and steady-state doses and amoxicillin/clavulanate concentrations were measured by a validated high-pressure liquid chromatography (HPLC)-tandem mass spectrometry method. Population pharmacokinetic analysis and Monte Carlo simulations were conducted using NONMEM’ 7.3.ResultsThree hundred twenty-five amoxicillin and 151 clavulanate blood samples were collected from 50 patients with a median age of 2.58 years (range: 0.08–15 years). A 3-compartment model for amoxicillin and a two-compartment model for clavulanate best described the data, in which allometric weight scaling and maturation functions were added a priori to scale for size and age. In addition, serum Cystatin C (sCysC) ‘as a marker for renal function’ and concomitant treatment with vasopressors were identified to have a significant influence on amoxicillin clearance. The typical population values of clearance for amoxicillin and clavulanate were 17.97 L/H/70 kg (95% CI:15.33–21.30 L/H/70 kg) and 12.20 L/H/70 kg (95% CI:10.54–14.55 L/H/70 kg), respectively. Four hourly dosing of 25 mg/kg (based on the amoxicillin component) was required to achieve 40% of the dosing interval for amoxicillin concentrations to be above MIC, and for clavulanate levels to be maintained above 2 mg/L. For patients with augmented renal function a 1 hour infusion was preferable to bolus dosing to achieve the therapeutic target.ConclusionsCurrent dosing regimens result in subtherapeutic concentrations in the early period of sepsis due to augmented renal clearance, which risks treatment failure in critically ill children.

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