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

## Marzia Lazzerini & David Tickell

Volume 89, Number 8, August 2011, 594-607

### Table 3. Pharmacokinetics of first-line oral antibiotics in children with severe acute malnutrition

Reference | Drug, dose (per kg) | No. of children | Absorption (%) |
C_{max} (μg/ml) and T_{max} (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. 1995^{30} |
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 K_{a} (f): 9.5*U K _{a} (nf): 3.9*M K _{a} (f): 8.4*M K _{a} (nf): 0.8*K K _{a} (f): 2.5*K K _{a} (nf): 1.6* |
K_{a} (f): 10.1K _{a} (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. 1991^{31} |
Amoxicillin, 25 mg | 15 | M T_{max}: 60K T _{max}: 120** |
T_{max}: 60 |
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(all groups adequate C_{max}, no values given) |
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Bolme et al. 1980^{32} |
Penicillin V, 30 000 IU | 16 | SAM T_{max}: 120SAM C _{max}: 5.8 |
T_{max}: 90C _{max}: 4.3 |
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Buchanan 1977^{33} |
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. 1984^{34} |
SMX, 22 mg | 17 | C_{max}: 41.4T _{max}: 120 |
C_{max} 36.8T _{max} 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; C_{max}, maximum concentration; f, fasting; IU, international units; K, kwashiorkor; K_{a}, 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; T_{max}, time to maximum concentration; TMP, trimethoprim; U, underweight; Vd, volume of distribution; ** P <* 0.05; ** *P*-value not specified.