Aminoglycoside Trough Levels, Renal Function and Hearing Acuity in Paediatric Patients at Kenyatta National Hospital

Abstract

Aminoglycosides are antibiotics used in pediatrics for the management of severe infections. In resource limited settings, monitoring of drug levels for efficacy and toxicity is minimal and dosing is largely empiric. This may lead to irreversible consequences such as hearing loss and renal toxicity. xvi Objective To determine aminoglycoside trough levels, risk of early hearing loss and renal toxicity among pediatric patients at KNH. Methods This prospective cohort study was conducted in the pediatric wards of the KNH between May and September, 2018. Patients aged 5 years and below receiving amikacin or gentamicin treatment were included. Renal function and hearing loss screening were determined at baseline and after treatment. Aminoglycoside trough levels were determined on day three before the third dose. Data on participant demographic characteristics, kidney function, hearing screening, drug serum trough levels were collected. The main outcome variable was aminoglycoside serum trough levels, hearing loss and Acute Kidney Injury (AKI). Results The prevalence of aminoglycoside use was 57.12%, 3 (10%) participants on amikacin and 30 (27%) on gentamicin had supra-therapeutic levels of >1 mcg/mL and >2 mcg/mL respectively. The predictors for supra-therapeutic levels were age <18 months (adjusted OR 0.36, 95% CI: 0.14 - 0.92), and weight <10kgs (adjusted OR 0.2, 95% CI: 0.07 - 0.53). The incidence of acute kidney injury (AKI) and hearing loss was 0.136 and 0.007. Conclusion There was a high risk of developing Acute Kidney Injury in patients who received aminoglycoside therapy particularly gentamicin. Therefore, there is need to review the existing aminoglycoside use protocols to include routine monitoring of patients on this therapy.