β-lactam precision dosing in critically ill children: Current state and knowledge gaps

Abstract

There has been emerging interest in implementing therapeutic drug monitoring and model-informed precision dosing of β-lactam antibiotics in critically ill patients, including children. Despite a position paper endorsed by multiple international societies that support these efforts in critically ill adults, implementation of β-lactam precision dosing has not been widely adopted. In this review, we highlight what is known about β-lactam antibiotic pharmacokinetics and pharmacodynamics in critically ill children. We also define the knowledge gaps that present barriers to acceptance and implementation of precision dosing of β-lactam antibiotics in critically ill children: a lack of consensus on which subpopulations would benefit most from precision dosing and the uncertainty of how precision dosing changes outcomes. We conclude with opportunities for further research to close these knowledge gaps.

Prediction of C‐reactive protein dynamics during meropenem treatment in neonates and infants

“…As a large proportion of blood cultures remains negative (52–80%) 1–3 (due to too small blood volumes for culturing, as the number of bacteria present can be low, or blood sampling after the initiation of antibiotics 4 ), antibiotics often cannot be dosed according to pharmacokinetic–pharmacodynamic (PKPD) targets based on minimum inhibitory concentration. Furthermore, there is a lack of consensus about the PKPD targets, 5 complicating appropriate dosing of antibiotics.…”