Advancing pediatric antimicrobial stewardship: Has pharmacodynamic dosing for gram-negative infections taken effect?

Bibliographic Details
Title: Advancing pediatric antimicrobial stewardship: Has pharmacodynamic dosing for gram-negative infections taken effect?
Authors: Lauren M. Puckett, Jason G. Newland, Jennifer E. Girotto
Source: Antimicrobial Stewardship & Healthcare Epidemiology, Vol 1 (2021)
Publisher Information: Cambridge University Press, 2021.
Publication Year: 2021
Collection: LCC:Infectious and parasitic diseases
LCC:Public aspects of medicine
Subject Terms: Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
More Details: Abstract Objective: To characterize pharmacodynamic dosing strategies used at children’s hospitals using a national survey. Design: Survey. Setting: Children’s hospitals. Participants: Volunteer sample of antimicrobial stewardship program (ASP) respondents. Methods: A nationwide survey was conducted to gain greater insight into the current adoption of nontraditional dosing methods and monitoring of select β-lactam and fluoroquinolone antibiotics used to treat serious gram-negative infections in pediatric populations. The survey was performed through the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative. Results: Of the 75 children’s hospitals that responded, 68% of programs reported adoption of pharmacodynamically optimized dosing using prolonged β-lactam infusions and 35% using continuous β-lactam infusions, although use was infrequent. Factors including routine MIC monitoring and formal postgraduate training and board certification of ASP pharmacists were associated with increased utilization of pharmacodynamic dosing. In addition, 60% of programs reported using pharmacodynamically optimized ciprofloxacin and 14% reported using pharmacodynamically optimized levofloxacin. Only 20% of programs monitored β-lactam levels; they commonly cited lack of published guidance, practitioner experience, and laboratomory support as reasons for lack of utilization. Less physician time dedicated to ASP programs was associated with lower adoption of optimized dosing. Conclusions: Use of pharmacodynamic dosing through prolonged and continuous infusions of β-lactams have not yet been routinely adopted at children’s hospitals. Further guidance from trials and literature are needed to continue to guide pediatric pharmacodynamic dosing efforts. Children’s hospitals should utilize these data to compare practices and to prioritize further research and education efforts.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2732-494X
Relation: https://www.cambridge.org/core/product/identifier/S2732494X21001996/type/journal_article; https://doaj.org/toc/2732-494X
DOI: 10.1017/ash.2021.199
Access URL: https://doaj.org/article/c800797e9f9040bcae45f2be15443b94
Accession Number: edsdoj.800797e9f9040bcae45f2be15443b94
Database: Directory of Open Access Journals
More Details
ISSN:2732494X
DOI:10.1017/ash.2021.199
Published in:Antimicrobial Stewardship & Healthcare Epidemiology
Language:English