ABSTRACT
This chapter focuses on the developmental aspects of disposition and toxicology of aminoglycosides and vancomycin in an attempt to delineate their rational use in the pediatric age group. Aminoglycosides and vancomycin are drugs with a low therapeutic index, and even recommended doses may be associated with serious adverse affects. Because of large interpatient variability in pharmacokinetics, individualization of therapy should be based on repeated monitoring of serum concentrations. More studies are needed to elucidate the molecular basis of aminoglycosides and vancomycin toxicology. Nephrotoxicity of aminoglycosides is enhanced by sodium or potassium depletion, dehydration, and by several commonly co-administered drugs, including amphotericin B, cephalothin and cephaloridine, cisplatinum, loop diuretics, vancomycin. Urinary excretion of N-Acetyl-β-glucosaminidase increased with both drugs at all doses tested; however, in most cases, amikacin produced a smaller increase. Vancomycin has been enjoying a renaissance in pediatric use due to the emergence of Staphylococcus resistant to other drugs.
