Malnutrition and Pharmacokinetics of Penicillin in Ethiopian Children

Abstract

Penicillin was given to 104 children with different nutritional status, normal, underweight, marasmus and kwashiorkor. Penicillin was given either intravenously, intramuscularly or orally and the plasma concentration was followed at regular times after administration. There was a significantly decreased plasma clearance of penicillin in all malnourished groups compared to the normal weight-for-age group. The half-lives of penicillin were, however, not significantly different between the nutritional groups. This was explained by the fact that also the volume of distribution was decreased in the malnourished group with a net result that the half-life was unchanged. The bioavailability was decreased if penicillin was given to non-fasting individuals. The greatest difference between fasting and non-fasting was seen in the severely malnourished children with marasmus and kwashiorkor. Therefore, it is advised that, if penicillin is given orally to very sick and undernourished children, the dose should be increased and preferably be given in the fasting state.

Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokinetics

“…21,[26][27][28][29] Characteristics of pharmacokinetic studies are detailed in Table 3, Table 4 and Table 5. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] All included studies refer to children with SAM unless otherwise stated.…”

“…30 Time to maximum concentration (C max ) of amoxicillin was significantly longer in children with kwashiorkor 31 and time to C max of penicillin V was longer, though not significantly, in all malnourished groups. 30 However, all malnourished subjects attained high enough serum levels for clinical effect to One child who was in shock had a trough level of 5.5 μg/ml; longer clearance was noted in children with hypothermia, high serum creatinine or large base excess. Systematic reviews Antibiotics in severely malnourished children Marzia Lazzerini & David Tickell occur (i.e.…”

“…[30][31][32] The oral bioavailability of penicillin V was the same regardless of nutritional status, although it was significantly reduced when the drug was taken with food. 30 Time to maximum concentration (C max ) of amoxicillin was significantly longer in children with kwashiorkor 31 and time to C max of penicillin V was longer, though not significantly, in all malnourished groups.…”

“…[30][31][32] The oral bioavailability of penicillin V was the same regardless of nutritional status, although it was significantly reduced when the drug was taken with food. 30 Time to maximum concentration (C max ) of amoxicillin was significantly longer in children with kwashiorkor 31 and time to C max of penicillin V was longer, though not significantly, in all malnourished groups. 30 However, all malnourished subjects attained high enough serum levels for clinical effect to One child who was in shock had a trough level of 5.5 μg/ml; longer clearance was noted in children with hypothermia, high serum creatinine or large base excess.…”

Drug disposition in obesity and protein–energy malnutrition

“…1 in underweight patients (74) . Drug clearance is also reduced in PCM for chloramphenicol, penicillin, quinine and isoniazid (51,53,(75)(76)(77)(78) . The additive influence of acute infection on drug disposition may also play a distinct role (79,80) .…”