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Lidocaine-amikacin combo reduces pain after injection in children with multidrug-resistant TB

26 Nov 2018

The addition of lidocaine to intramuscular amikacin lessens pain immediately after injection in children with multidrug-resistant (MDR) tuberculosis (TB), according to a new study. In addition, coadministration of lidocaine does not alter amikacin area under the concentration time curve or maximum plasma concentration.

A total of 12 children were enrolled (median age 11.5 years; interquartile range [IQR], 9.9–13.4 years). Nearly after the amikacin injection, pain scores reported by participants were lower when lidocaine was coadministered relative to without lidocaine (1.0 [IQR, 0.5–2.0] vs 2.5 [IQR, 1.0–4.0]; p=0.004)

The median area under the concentration time curve0–8 was 109.0 μg × h/mL (IQR, 84.7–121.3) and the median maximum plasma concentration of amikacin was 36.7 μg/mL (IQR, 34.1–40.5) with lidocaine compared with 103.3 μg × h/mL (IQR, 81.7–135.0; p=0.814) and 34.1 μg/mL (IQR, 35.6–46.4; p=0.638) without lidocaine, respectively.

This randomized crossover trial included children 8–18 years of age who were receiving amikacin for MDR-TB treatment in South Africa. A 15-mg/kg dose of intramuscular amikacin with and without additional lidocaine (0.2–0.4 mg/kg) was administered to patients on different days. Participants were then randomly assigned to the order of the treatments (the sequence).

Both children and staff completing evaluations were blinded to the sequence. The investigators drew samples predose and at 1, 2, 4, 6 and 8 hours postdose for measurement of plasma amikacin concentrations.

Participants used the Wong Baker FACES pain scale (0–5) to assess their pain predose, immediately after the injection, and then at 30 and 60 minutes. Noncompartmental analysis was conducted to calculate pharmacokinetic measures.

“Currently recommended treatment for MDR-TB includes 4–8 months of an injectable medication, which is poorly tolerated,” the investigators said.

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