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Variation in target attainment of β-lactam antibiotic dosing between international pediatric formularies

Gastine, S; Hsia, Y; Clements, M; Barker, CI; Bielicki, J; Hartmann, C; Sharland, M; (2021) Variation in target attainment of β-lactam antibiotic dosing between international pediatric formularies. Clinical Pharmacology & Therapeutics , 109 (4) pp. 958-970. 10.1002/cpt.2180. Green open access

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Abstract

As antimicrobial susceptibility of common bacterial pathogens decreases, ensuring optimal dosing may preserve the use of older antibiotics in order to limit the spread of resistance to newer agents. β-lactams represent the most widely prescribed antibiotic class, yet most were licensed prior to legislation changes mandating their study in children. As a result, significant heterogeneity persists in the pediatric doses used globally, along with quality of evidence used to inform dosing. This review summarizes dose recommendations from the major paediatric reference sources and tries to answer the question: does β-lactam dose heterogeneity matter? Does it impact on pharmacodynamic (PD) target attainment? For three important severe clinical infections - pneumonia, sepsis and meningitis - pharmacokinetic (PK) models were identified for common β-lactam antibiotics. Real-world demographics were derived from three multi-center point prevalence surveys. Simulation results were compared with minimum inhibitory concentration (MIC) distributions, to inform appropriateness of recommended doses in targeted and empiric treatment. Whilst cephalosporin dose regimens are largely adequate for target attainment, they also pose most risk of neurotoxicity. Our review highlights aminopenicillin, piperacillin and meropenem doses as potentially requiring review/optimisation in order to preserve the use of these agents in future.

Type: Article
Title: Variation in target attainment of β-lactam antibiotic dosing between international pediatric formularies
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/cpt.2180
Publisher version: https://doi.org/10.1002/cpt.2180
Language: English
Additional information: This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Beta-lactams, PKPD, Target attainment, pediatrics
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10122067
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