Timing of Correct Parenteral Antibiotic Initiation and Outcomes From Severe Bacterial Community-acquired Pneumonia in Children

Muszynski, Jennifer A.; Knatz, Nina L.; Sargel, Cheryl; Fernández, Soledad; Marquardt, David J.; Hall, Mark W.

doi:10.1097/inf.0b013e3181ff64ec

Cited by 40 publications

(32 citation statements)

References 22 publications

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“…34 it has recently been demonstrated that delays in the appropriate choice and dose of antimicrobials in critically ill children with severe bacterial community-acquired pneumonia lead to longer durations of mechanical ventilation, icU lengths of stay and hospital lengths of stay. 35 Prolonged infusions of β-lactams have been found to increase the probability of attaining bactericidal activity by prolonging the time to reach maximum concentrations, thereby increasing ft>mic. 11,21,36 in clinical practice, prolonged infusions have also demonstrated decreased mortality rates in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics of Piperacillin/Tazobactam in Critically Ill Young Children

Cies

Shankar

Schlichting

et al. 2014

Pediatric Infectious Disease Journal

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Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics of Piperacillin/Tazobactam in Critically Ill Young Children

Cies

Shankar

Schlichting

et al. 2014

Pediatric Infectious Disease Journal

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“…This is critical because suboptimal anti-infective therapy is associated with worse outcomes. 6,[33][34][35][36][37][38][39] Systematic research using ex vivo circuits, large animal models, and population pharmacokinetic studies are indicated to improve antimicrobial dosing regimens and, therefore, patient outcomes during ECLS and CRRT.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of Continuous Infusion Meropenem With Concurrent Extracorporeal Life Support and Continuous Renal Replacement Therapy: A Case Report

Cies

Moore²,

Conley

et al. 2016

The Journal of Pediatric Pharmacology and Therapeutics

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Pharmacokinetic parameters can be significantly altered for both extracorporeal life support (ECLS) and continuous renal replacement therapy (CRRT). This case report describes the pharmacokinetics of continuousinfusion meropenem in a patient on ECLS with concurrent CRRT. A 2.8-kg, 10-day-old, full-term neonate born via spontaneous vaginal delivery presented with hypothermia, lethargy, and a ~500-g weight loss from birth. She progressed to respiratory failure on hospital day 2 (HD 2) and developed sepsis, disseminated intravascular coagulation, and liver failure as a result of disseminated adenoviral infection. By HD 6, acute kidney injury was evident, with progressive fluid overload >1500 mL (+) for the admission. On HD 6 venoarterial ECLS was instituted for lung protection and fluid removal. On HD 7 she was initiated on CRRT. On HD 12, a blood culture returned positive and subsequently grew Pseudomonas aeruginosa with a minimum inhibitory concentration (MIC) for meropenem of 0.25 mg/L. She was started on vancomycin, meropenem, and amikacin. A meropenem bolus of 40 mg/kg was given, followed by a continuous infusion of 10 mg/kg/hr (240 mg/kg/day). On HD 15 (ECLS day 9) a meropenem serum concentration of 21 mcg/mL was obtained, corresponding to a clearance of 7.9 mL/kg/min. Repeat cultures from HDs 13 to 15 (ECLS days 7-9) were sterile. This meropenem regimen was successful in providing a target attainment of 100% for serum concentrations above the MIC for ≥40% of the dosing interval and was associated with a sterilization of blood in this complex patient on concurrent ECLS and CRRT circuits.

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“…Studies conducted in Italy in 2012, showed that intravenous administration of antimicrobials has several far-reaching effects on pediatric patients and treatment itself (10). In the opinion of child psychologists, parenteral route of administration is considered to be traumatic for the child, with more rapid appearance of adverse effects (11).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Drug Treatment of Bronchopneumonia at the Pediatric Clinic in Sarajevo

Zec

Selmanovic

Andrijic

et al. 2016

Med Arh

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Introduction:Bronchopneumonia is the most common clinical manifestation of pneumonia in pediatric population and leading infectious cause of mortality in children under 5 years. Evaluation of treatment involves diagnostic procedures, assessment of disease severity and treatment for disease with an emphasis on vulnerability of the population.Aim:To determine the most commonly used antibiotics at the Pediatric Clinic in Sarajevo and concomitant therapy in the treatment of bronchopneumonia.Patients and Methods:The study was retrospective and included a total of 104 patients, hospitalized in pulmonary department of the Pediatric Clinic in the period from July to December 2014. The treatment of bronchopneumonia at the Pediatric Clinic was empirical and it conformed to the guidelines and recommendations of British Thoracic Society.Results and Discussion:First and third generation of cephalosporins and penicillin antibiotics were the most widely used antimicrobials, with parenteral route of administration and average duration of treatment of 4.3 days. Concomitant therapy included antipyretics, corticosteroids, leukotriene antagonists, agonists of β2 adrenergic receptor. In addition to pharmacotherapy, hospitalized patients were subjected to a diet with controlled intake of sodium, which included probiotic-rich foods and adequate hydration. Recommendations for further antimicrobial treatment include oral administration of first-generation cephalosporins and penicillin antibiotics.Conclusion:Results of the drug treatment of bronchopneumonia at the Pediatric Clinic of the University Clinical Center of Sarajevo are comparable to the guidelines of the British Thoracic Society. It is necessary to establish a system for rational use of antimicrobial agents in order to reduce bacterial resistance.

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Timing of Correct Parenteral Antibiotic Initiation and Outcomes From Severe Bacterial Community-acquired Pneumonia in Children

Abstract: In our critically ill children with severe bacterial CAP, longer delays in receipt of appropriate empiric antibiotics were independently associated with adverse outcomes.

Cited by 40 publications

References 22 publications

Population Pharmacokinetics of Piperacillin/Tazobactam in Critically Ill Young Children

Population Pharmacokinetics of Piperacillin/Tazobactam in Critically Ill Young Children

Pharmacokinetics of Continuous Infusion Meropenem With Concurrent Extracorporeal Life Support and Continuous Renal Replacement Therapy: A Case Report

Evaluation of Drug Treatment of Bronchopneumonia at the Pediatric Clinic in Sarajevo

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