Optimized Antimicrobial Dosing Strategies: A Survey of Pediatric Hospitals

Abstract

Abstract:Background Extended-interval aminoglycoside (EIAG) and extended-and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited. ObjectiveThe objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA. Study Design, Setting, and ParticipantsA national survey of children's hospitals was conducted. A single practitioner from each target hospital was identified through the Children's Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing. Main Outcome MeasureThe main outcome measure was the percentage utilization of the dosing strategies, with secondary outcomes being the reasons for not using these dosing strategies. ResultsSeventy-seven of 215 identified practitioners (36 %) participated in the survey. EIAG, EIBL, and CIBL dosing were utilized in 63 %, 24 %, and 13 % of responding hospitals, respectively. The most common reasons for not using EIAG were concern regarding lack of efficacy data (56 %) and concern regarding the duration of the drug-free period (41 %). Respondents who did not utilize EIBL cited concern due to lack of pediatric EIBL efficacy data (54 %), the need for more intravenous access (54 %), intravenous medication compatibility issues (39 %), and the time during which the patient is attached to an intravenous infusion (31 %). ConclusionThis survey of children's hospitals indicates that EIAG is used in over 50 % of hospitals, but there is some lag in adoption of EIBL and CIBL dosing, both of which are used in fewer than 25 % of hospitals.Additional studies may provide much-needed evidence to increase the utilization of these strategies.2

Dose optimization of piperacillin/tazobactam in critically ill children

“…47 However, it should be noted that, we have specifically chosen not to select higher amounts per dose for intermittent dosing regimens (max. 100/12.5 mg per kg piperacillin/tazobactam) than currently recommended.…”

“…Despite the higher PTA with these prolonged and continuous infusions, we acknowledge that these dosing regimens may have important implications on drug administration practices, as intravascular access is frequently limited and drug incompatibilities with piperacillin/tazobactam often occur. 47,49 Therefore, a rational choice in dosing regimen is advised, depending on the individual patient characteristics, site of infection and target MIC.…”

Clinical Outcomes With Continuous Nafcillin Infusions in Children

“…It is possible that fewer young children received CI nafcillin at our institution because of prescribers' concerns about intravenous access and that these concerns have been previously cited as a common reason for not using CI beta-lactams. 23 Although we cannot definitively extrapolate similar efficacy to younger children, it is anticipated that similar clinical and microbiological cure rates would be observed. Continuously infused nafcillin appeared to be well tolerated in this cohort.…”

“…[16][17][18][19][20][21][22] Despite PK and PD justifications for using CI nafcillin in children, there is a general lack of pediatric data examining outcomes or efficacy with CI nafcillin, and this has been the reason cited for not using the dosage strategy. 5,10,23 The objective of the present study was to describe the clinical outcomes of CI nafcillin in pediatric patients.…”

Extended Infusion of Piperacillin/Tazobactam in Children

“…Over half of the respondents not utilizing extended-infusion beta-lactams indicated the primary reason is due to lack of pediatric efficacy data. 24 This study is the first pediatric study describing outcomes with extended-infusion TZP. Our cohort of children was being treated for a variety of Gram-negative infections, and extended-infusion TZP was associated with a favorable response.…”