Background Paediatric oncology patients with febrile neutropenia (FN) are at high risk of developing life threatening infections. In our institution, they are empirically treated with multiple daily dosing (MDD) of amikacin if persistently febrile after treatment with piperacillin–tazobactam.
Purpose With the aim of optimising dosing strategies, we evaluated the safety of MDD amikacin in the paediatric oncology FN population.
Material and methods Design: a retrospective medical record review. Setting: haematology–oncology service of a children’s hospital. Patients: aged 1–18 years with a diagnosis of malignancy or undergoing haematopoietic stem cell transplantation who received amikacin for the treatment of FN between January 2013 and December 2014, with plasma amikacin concentrations determined after the first dose. Measurements: demographic data, amikacin dosing information, plasma amikacin concentrations, development of nephrotoxicity and ototoxicity, clinical outcomes and mortality were collected and analysed.
Results Of the 40 FN episodes evaluated, all patients achieved amikacin trough levels within the desired range of <10 µg/mL after the first dose. There was no documented nephrotoxicity or ototoxicity. The first dose was not effective in achieving target peak levels of 30–40 µg/mL. Within 3 days of initiating amikacin, 72.5% achieved target peak levels and 82.5% achieved defervescence. The median number of days of therapy was 4 (range 2–9 days). No infection related mortality was observed for 30 days following the onset of FN.
Conclusion The use of multiple daily dosing of amikacin, in combination with piperacillin–tazobactam, is a safe management strategy for paediatric oncology patients with febrile neutropenia. Further studies are needed to optimise the dosing of amikacin so as to achieve clinical outcomes more rapidly.
No conflict of interest