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Risk and management of an acute aminoglycoside overdose : case report and literature review

Boekbijdrage - Boekabstract Conferentiebijdrage

Background Aminoglycosides have a narrow therapeutic range and therapeutic drug monitoring (TDM) is widely used to prevent nephro- and ototoxicity during prolonged therapy. However, the risks and management of an acute overdose of aminoglycosides are less well-known. We describe the case of a young child who received an amikacin overdose together with an overview of management strategies, based on a literature review. Methods A literature search for cases of aminoglycoside overdoses was performed in PubMed. Results Case. An amikacin dose of 125 mg/kg (recommended dose: 15 mg/kg q24h) was accidentally administered to a girl of five months old with pyelonephritis and normal renal function. On the advice of the Belgian Poison Center and the pediatric nephrologists, she was started on acute hemodialysis. Hemodialysis was initiated seven hours after administration and continued for four hours until subtherapeutic trough plasma levels were reached. Amikacin levels showed a rapid decline before the start of and during hemodialysis. Nephro- or ototoxicity was not observed during follow-up (now almost one year after the event). Literature review. A number of case reports on acute overdoses (3 to 20 times the recommended dose) have been published for amikacin (6), gentamicin (6) and kanamycin (3). Two-thirds of these cases concern young children. Various treatment strategies have been applied: supportive therapy (intravenous hydration, monitoring of the vital signs and renal function, and aminoglycoside TDM), hemodialysis, peritoneal dialysis, and exchange transfusion. From these interventions, hemodialysis is most effective at removing aminoglycosides from the body. This was clearly demonstrated in one adult patient with end-stage renal disease. Four out of the fifteen patients (~25%) experienced nephro- or oto-toxic effects. The incidence of toxicity did not differ between patients on supportive therapy and those treated with hemodialysis. Discussion Because of their low molecular mass, small volume of distribution, and low protein binding, aminoglycosides are efficiently removed from the body by extracorporeal treatments. However, scientific evidence on the added value of hemodialysis above supportive therapy for intoxications with aminoglycosides is scarce and mainly based on expert opinion, except in patients with pre-existing renal impairment. When hemodialysis is preferred, it is advisable to start as fast as possible with high-flux intermittent hemodialysis.
Boek: BVK-SBP Congress 2023, Abstracts
Aantal pagina's: 1
Jaar van publicatie:2023