A randomized clinical trial was performed in children with
cancer,
fever and
neutropenia, to evaluate the efficacy of
amikacin once daily versus thrice daily dosing plus
carbenicillin in both groups. Fifty patients were included, 25 patients in group A who received
amikacin once daily and 25 in group B who received
amikacin thrice daily. No intergroup 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 respectively (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 treatment were 10-60 and 7-25 micrograms/mL in groups A and B respectively, and the serum
creatinine levels were 0.3 - 0.7 for group A and 0.2 - 0.8 mg/dL for group B; none of the patients presented a
creatinine above 40% of the basal value. Three patients of group A had
amikacin levels higher than 40 micrograms/mL without increasing the
creatinine levels; our observations do not suggest that toxicity is higher. We conclude that the administration of
aminoglycoside once daily seems to be as effective as the traditional dosing.