Table 3. Pharmacokinetics of first-line oral antibiotics in children with severe acute malnutrition.
Reference | Drug, dose (per kg) | No. of children | Absorption (%) |
Cmax (μg/ml) and Tmax (min) |
Vd (l/kg) protein binding (%) |
Clearance (ml/kg/h) |
Half life (min) |
AUC (μg.min/ml) |
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---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Malnourished | Eutrophic | Malnourished | Eutrophic | Malnourished | Eutrophic | Malnourished | Eutrophic | Malnourished | Eutrophic | Malnourished | Eutrophic | ||||||||
Bolme et al. 199530 | Penicillin V, 20 mg | 47 | U (f): 35.9* U (nf): 29.8* M (f): 66.1* M (nf): 22.7* K (f): 82.6* K (nf): 27.1* |
f: 54.8 nf: 47.0 |
U Ka (f): 9.5* U Ka (nf): 3.9* M Ka (f): 8.4* M Ka (nf): 0.8* K Ka (f): 2.5* K Ka (nf): 1.6* |
Ka (f): 10.1 Ka (nf): 2.2 |
U (f): 40.8* U (nf): 62.7* M (f): 54.2* M (nf): 145.2* K (f): 139.6* K (nf): 109.6* |
f: 39.1 nf: 75.6 |
U (f): 476.7* U (nf): 396.0* M (f): 941.7* M (nf): 323.2* K (f): 975.2* K (nf): 319.5* |
f: 493.6 nf: 423.4 |
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Zerihun et al. 199131 | Amoxicillin, 25 mg | 15 | M Tmax: 60 K Tmax: 120** |
Tmax: 60 | |||||||||||||||
(all groups adequate Cmax, no values given) | |||||||||||||||||||
Bolme et al. 198032 | Penicillin V, 30 000 IU | 16 | SAM Tmax: 120 SAM Cmax: 5.8 |
Tmax: 90 Cmax: 4.3 |
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Buchanan 197733 | Benzyl-penicillin, dose NS | Adult serum versus pooled serum of 24 kwashiorkor children | % free drug similar (N: 59.1%, K: 64.0%) so Vd likely unaffected | ||||||||||||||||
TMP-SMX | PB: N: 71.9%, K: 93–96% | ||||||||||||||||||
Bravo et al. 198434 | SMX, 22 mg | 17 | Cmax: 41.4 Tmax: 120 |
Cmax 36.8 Tmax 150 |
Vd: 0.529 | Vd: 0.529 | 41 | 83 | 9.4 * | 4.9 | 9.55 * | 5.47 |
AUC, area under the plasma concentration time curve; Cmax, maximum concentration; f, fasting; IU, international units; K, kwashiorkor; Ka, absorption rate constant; M, marasmus; MK, marasmic kwashiorkor; n, normal (controls); nf, non-fasting; NS, not stated; PB, protein binding; SAM, severe acute malnutrition; SMX, sulfamethoxazole; Tmax, time to maximum concentration; TMP, trimethoprim; U, underweight; Vd, volume of distribution; * P < 0.05; ** P-value not specified.