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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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Most Read Articles
4 days ago
Poor overall diet quality, particularly low intake of vegetable protein, appears to put elderly adults at greater risk of frailty, a recent study has found.
Pearl Toh, 15 Jul 2019
In addition to the known evils of maternal smoking during pregnancy on the son’s semen quality, prenatal exposure to paternal smoking can also be harmful, according to data from the large Danish National Birth Cohort (DNBC) presented at the ESHRE 2019 Meeting.
15 Jul 2019
Fluticasone, swallowed from a multidose inhaler, and oral viscous budesonide slurry have comparable efficacies as initial treatment for eosinophilic oesophagitis, a recent study has found.
2 days ago
Health-related quality of life (HRQoL) among patients with kidney stone is worse in those who are young and female than those who are older and male, according to a recent study. Non-Caucasian patients also have a lower HRQoL.