Once-daily or less frequent aminoglycoside dosing: plasma concentration monitoring in children 1 month to younger than 18 years

For children 1 month to younger than 18 years, there are limited data assessing the association between clinical efficacy and aminoglycoside peak plasma concentration or area under the concentration–time curve (AUC). Targets are largely extrapolated from data in adults.

The utility of aminoglycoside AUC monitoring in children is restricted by the requirement for repeated blood sampling, and the limited availability of appropriate Bayesian dosing software or a clinician with expertise in manual AUC calculations.

Note: Aminoglycoside AUC monitoring should only be used if software appropriate for children is available or an expert is available who can manually calculate the AUC.

Aminoglycoside AUC monitoring should ideally be used in children:

with pre-existing kidney impairment
receiving an aminoglycoside for directed therapy
with cystic fibrosis
with altered pharmacokinetics.

Note: If appropriate aminoglycoside AUC monitoring is not available, use trough plasma concentration monitoring.

If appropriate aminoglycoside AUC monitoring is not available and monitoring is indicated, monitor the patient using the plasma concentration. Many paediatric centres monitor the trough (predose) plasma concentration alone to limit toxicity (rather than peak concentrations to monitor for efficacy); however, nephrotoxicity and ototoxicity may still occur despite normal trough plasma concentrations. To minimise toxicity, the trough plasma concentration should not exceed 1 mg/L for gentamicin or tobramycin, or 4 mg/L for amikacinYamada 2021.