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Klin Padiatr 2021; 233(03): 123-126
DOI: 10.1055/a-1352-5053
Original Article

Prospective Audit of Gentamicin Drug Monitoring Practice in a Pediatric Cancer Center

Prospektives Audit des Gentamicin Drug Monitorings in einem Kinderkrebszentrum
Sarah Herberger
1   Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
,
Nadine Oberkircher
1   Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
,
Gentiana I. Wenzel
2   Otorhinolaryngology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
,
Dietmar Hecker
2   Otorhinolaryngology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
,
Gudrun Wagenpfeil
3   Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
,
Rhoikos Furtwängler
1   Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
,
Sören L. Becker
4   Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
,
Cihan Papan
4   Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
,
Norbert Graf
1   Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
,
Arne Simon
1   Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
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Zusammenfassung

Hintergrund Gentamicin kommt in vielen pädiatrisch onkologischen Behandlungszentren in der Erstlinien-Kombinationstherapie bei Fieber und Granulozytopenie zum Einsatz. Seit 2011 verwenden wir hierzu eine Dosierung von 250 mg/m2 KOF (max. 10 mg/kg, max. 400 mg) als tgl. Einmalgabe nach der deutschen Leitlinie.

Patienten und Methoden In diesem prospektiven Audit (Februar 2011 – Dezember 2019) wurden bei 66 kinderonkologischen Patienten 105 Gentamicin-Zyklen in Hinblick auf die Adhärenz zum Dosierungsstandard und auf die Ergebnisse des Drug Monitorings analysiert.

Ergebnisse Die Adhärenz mit dem neuen Dosierungsschema war hoch (89%). In 64% der Zyklen wurde ein Spitzenspiegel (1 h nach der 2. Gabe) im Zielbereich (Cmax; 10–20 µg/ml) erreicht. Cmax korrelierte signifikant mit der Dosis in mg/m2 KOF (p=0,007), jedoch nicht mit der Dosis in mg/kg (p=0,366). Ein Lebensalter unter 6 Jahre beeinflusste dieses Ergebnis nicht. Der Gentamicin Ctrough (8–10 h nach der zweiten Gabe) lag in 93% der Zyklen unter 2 µg/ml und korrelierte nicht mit der Dosis. Kein Patient in diesem Audit erfüllte die Kriterien für eine Gentamicin-assoziierte Nephrotoxizität.

Diskussion und Schlussfolgerung Dieses prospektive Audit der tgl. Einmalgabe von Gentamicin bei nierengesunden pädiatrisch-onkologischen Patienten bestätigt die praktische Anwendbarkeit und Sicherheit der Dosierung in mg/m2 nach der deutschen Leitlinie. Aufgrund der eingeschränkten Indikationen für Gentamicin in der Erstlinientherapie ist eine prospektive multizentrische Studie zur Bestätigung dieser Beobachtungen wünschenswert.

Abstract

Background Many pediatric cancer centers still use Gentamicin as first line combination treatment in patients with fever and neutropenia. Since 2011, our center has implemented a dosing regimen with 250 mg/m2 BSA (max. 10 mg/kg, max. 400 mg) as a single daily infusion according to the German guideline.

Patients and Methods In this prospective audit (February 2011 to December 2019), 105 Gentamicin treatment cycles were analyzed in 66 pediatric cancer patients, focusing on adherence to the dosing regimen and the drug monitoring results.

Results Adherence to the dosing regimen was high (89%). In 64% of all cycles, the Cmax (drawn 1 h after the 2nd dose) reached the target of 10–20 µg/ml. Cmax significantly correlated with dosing in mg/m2 BSA (p=0,007), but not with dosing in mg/kg (p=0,366). Age below 6 years did not influence these results. The Gentamicin Ctrough (drawn 8–10 h after the second dose) was < 2 µg/ml in 93% of all cycles without any dose correlation. None of the patients experienced Gentamicin-associated nephrotoxicity.

Discussion and Conclusion This prospective audit of single daily infusion Gentamicin in pediatric cancer patients without impaired renal function elicits the feasibility and safety of the dosing regimen in mg/m2 BSA according to the German guideline. Since indications for first-line gentamicin are limited, a multicenter prospective study would be advantageous to confirm these observations.

Key words

children with cancer - febrile neutropenia - empiric antibiotic treatment - gentamicin - therapeutic drug monitoring

Schlüsselwörter

Kinder mit Krebserkrankung - febrile Granulozytopenie - empirische Antibiotikatherapie - Gentamicin - therapeutisches Drug Monitoring

Supplementary Material



Publikationsverlauf

Artikel online veröffentlicht:
18. Februar 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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