The majority of paediatric and neonatal units in the UK used traditional weight-based methods for IV infusions and only 40% of responding units had established SCI. This local implementation of SCI resulted in a wide variation of presentations and concentrations and thus there is no true 'standardisation'. Further research should be conducted on harmonising these SCI across neonatal and paediatric care to facilitate adoption across all units.

Posthemorragic hydrocephalus is a relatively common condition in prematures, often requiring ventriculoperitoneal shunts. We report a case of methicillin-resistant Staphylococcus aureus infection of a ventriculoperitoneal shunt in a premature neonate which failed conventional intravenous treatment. Despite the absence of published guidelines, we used available data and expert advice to treat the patient with intraventricular vancomycin. The treatment was successful in eradicating the infection without observed toxicity. This case highlights the need for international guidelines on intraventricular treatment for neonates.

Aim Vancomycin is frequently used in paediatric hospitals. Data suggest trough levels of 10–20 mg/L are needed to achieve bacterial killing. This study aimed to evaluate if commonly used dosing regimens are efficient in reaching these levels and if therapeutic drug monitoring (TDM) was appropriately used. Methods All children receiving intravenous vancomycin at the Children´s Hospital Iceland between 2012 and 2016 were included. Vancomycin trough levels were registered. Student t test, Wilcoxon test and regression models were used for statistical analysis. Results A total of 105 children received 163 vancomycin treatments (55/105 neonates). Average daily dose in neonates was 23.4 mg/kg/day and 38.4 mg/kg/day for older children. No TDM was done in 58 treatments (35.6%). First trough levels were <10mg/L in 52.4% and <15mg/L in 92% of cases. Therapeutic levels were less likely achieved in children with malignancy (11.8%) compared with others (36.8%, p = 0.09). Conclusions In more than half of the cases, trough drug levels were <10 mg/L and malignancy was associated with the lowest probability of reaching therapeutic levels. This study suggests that starting doses of vancomycin in children should be higher, especially in relation to malignant diseases and supports the importance of antibiotic stewardship to ensure optimal antibiotic use.

BackgroundPatient adherence to treatment plays a fundamental role in clinical outcome, healthcare costs, treatment safety and quality of patients’ life.PurposeThe objective of this study was to calculate patient adherence to treatment with tumour necrosis factor alpha (TNFα) inhibitors (adalimumab, etanercept and infliximab) in rheumatoid arthritis (RA) and psoriatic arthritis (PsA).Material and methodsObservational cohort study based on two registries: Firstly, the ICEBIO registry, which is a national registry on biologic use for rheumatic conditions in Iceland and secondly the medication prescription registry system at our hospital. The present study included 499 patients registered in ICEBIO, 321 with RA and 178 with PsA. All patients were receiving their first biologic treatment during the study period (2009–2013). Medication adherence was calculated using medication possession ratio (MPR) and proportion of days covered (PDC) to create an adherence score, which was used to classify patients as adherent (80% or higher for either score) or non-adherent.ResultsOf the 499 patients 53% received infliximab, 34% etanercept, and 13% adalimumab. Patients treated with infliximab were more likely to adhere to treatment than those treated with etanercept or adalimumab (p < 0.0001). With infliximab, patients showed 99.1% (CI 98.7–99.6) and 94.9% (CI 94.0–95.7) adherence, calculated with MPR and PDC, respectively. In contrast, etanercept showed 89.6% (CI 87.5–91.8) and 81.7% (CI 79.6–83.8), and adalimumab 94.3% (CI 92.0–96.7) and 86.0% (CI 83.2–88.9), respectively. If MPR and PDC were combined, more than 80% of patients were adherent to treatment.ConclusionMedication adherence is high in Icelandic RA and PsA patients treated with TNFα inhibitors. Patients on etanercept had the lowest rate of adherence and those on infliximab had the highest rate. Mode of administration probably play a fundamental role in adherence to treatment among rheumatic patients.References and/or acknowledgementsNo conflict of interest.