AMIKACIN ONCE-DAILY IN FEBRILE NEUTROPENI C CHILDREN

A randomized clinical trial was performed in children with cancer, fev er and neutropenia, to evaluate the efficacy of amikacin once daily ve rsus thrice daily dosing plus carbenicillin in both groups. Fifty pati ents were included, 25 patients in group A who received amikacin once daily and 25 in group B who received amikacin thrice daily. No intergr oup differences were observed, i.e., fever diminished in a median of 6 days (2-8 days) vs. 7 days : (3-12 days) in groups A and B respective ly (p = 0.37); clinical improvement was observed in a median of 6 days (3-10 days) vs 7 days (2-14 days) (p = 0.68). One patient in group A and two in B died. The peak levels of amikacin on the 7th day of treat ment were 10-60 and 7-25 mu g/mL in groups A and B respectively, and t he serum creatinine levels were 0.3 - 0.7 for group A and 0.2 - 0.8 mg /dL for group Bi none of the patients presented a creatinine above 40% of the basal value. Three patients of group A had amikacin levels hig her than 40 mu g/mL without increasing the creatinine levels; our obse rvations do not suggest that toxicity is higher. We conclude that the administration of aminoglycoside once daily seems to be as effective a s the traditional dosing.