Amikacin pharmacokinetics, target attainment, and predictors in critically ill children: a retrospective cohort

values outside therapeutic targets. Independent predictors of Vd included age, creatinine clearance (CrCl), and alanine aminotransferase (ALT), while CL was independently associated with age, CrCl, urea, and ALT. Conclusion: Critically ill children demonstrate expanded Vd and increased CL, contributing to inadequate early amikacin exposure under standard dosing. Early PK-guided dosing and model-informed strategies may improve target attainment and individualized therapy in this high-risk population. What is Known: Amikacin PK in children is variable, and standard dosing may not consistently achieve therapeutic targets. Critically ill pediatric patients often experience altered drug disposition and clearance, which can affect amikacin exposure and response. What is New: This study quantified amikacin PK parameters in critically ill children receiving routine TDM in the PICU. Expanded Vd and increased CL were identified, with age, CrCl, urea, and ALT associated with variability in amikacin PK.