Dose Evaluation and Optimization of Amoxicillin in Children Treated for Lyme Disease.

Details

Serval ID
serval:BIB_27FAF1BE5206
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Dose Evaluation and Optimization of Amoxicillin in Children Treated for Lyme Disease.
Journal
Journal of clinical pharmacology
Author(s)
Ravix A., Gotta V., Pfister M., Berger C., Glauser A., Paioni P., Csajka C., Guidi M.
ISSN
1552-4604 (Electronic)
ISSN-L
0091-2700
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Amoxicillin is commonly used to treat erythema migrans in the first stage of Lyme disease in children, with a recommended dose of 50 mg/kg/day, administered three times a day (q8h). This model-based simulation study aimed to determine whether splitting the same daily dose into two administrations (q12h) would provide comparable drug exposure. A pharmacokinetic model suitable for a pediatric population (age: 1 month to 18 years, weight: 4-80 kg) was selected through a literature review. Simulations were performed with 15,000 virtual patients receiving 16.67 mg/kg/dose q8h, 25 mg/kg/dose q12h, or other q12h dosing variations. The target therapeutic level was defined by the percentage of time that the unbound drug concentration remained above the minimum inhibitory concentration (% fT > MIC) specific to Borrelia burgdorferi, with MICs of 0.06, 0.25, 1, 2, and 4 mg/L, requiring at least 40% and 50% of time for effective treatment. Probability of target attainment (PTA) was considered acceptable if it exceeded 50%, allowing for comparison of dosing schedules. Results indicated that the 50 mg/kg/day divided q12h regimen provided similar drug exposure to the q8h regimen for MICs below 2 mg/L (PTAs >50%). For a MIC of 2 mg/L, PTA was achieved with a higher dose of 30 mg/kg/dose q12h. However, for a MIC of 4 mg/L, the PTA criterion was not met. These findings suggest that a twice-daily dosing of 25 mg/kg/dose provides comparable bactericidal activity to the thrice-daily regimen for MICs between 0.06 and 1 mg/L. This simplified regimen may improve adherence and treatment implementation in children.
Keywords
amoxicillin, dose optimization, erythema migrans, model‐based simulation, pediatric, population pharmacokinetic model
Pubmed
Web of science
Create date
31/01/2025 16:53
Last modification date
27/02/2025 8:07
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