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Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines

BACKGROUND: Paediatric global antibiotic guidelines are inconsistent, most likely due to the limited pharmacokinetic and efficacy data in this population. We investigated factors underlying variation in antibiotic dosing using data from five global point prevalence surveys. METHODS & FINDINGS: D...

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Autores principales: Clements, Michelle N., Russell, Neal, Bielicki, Julia A., Ellis, Sally, Gastine, Silke, Hsia, Yingfen, Standing, Joseph F., Walker, A. Sarah, Sharland, Mike
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159011/
https://www.ncbi.nlm.nih.gov/pubmed/34043696
http://dx.doi.org/10.1371/journal.pone.0252223
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author Clements, Michelle N.
Russell, Neal
Bielicki, Julia A.
Ellis, Sally
Gastine, Silke
Hsia, Yingfen
Standing, Joseph F.
Walker, A. Sarah
Sharland, Mike
author_facet Clements, Michelle N.
Russell, Neal
Bielicki, Julia A.
Ellis, Sally
Gastine, Silke
Hsia, Yingfen
Standing, Joseph F.
Walker, A. Sarah
Sharland, Mike
author_sort Clements, Michelle N.
collection PubMed
description BACKGROUND: Paediatric global antibiotic guidelines are inconsistent, most likely due to the limited pharmacokinetic and efficacy data in this population. We investigated factors underlying variation in antibiotic dosing using data from five global point prevalence surveys. METHODS & FINDINGS: Data from 3,367 doses of the 16 most frequent intravenous antibiotics administered to children 1 month–12 years across 23 countries were analysed. For each antibiotic, we identified standard doses given as either weight-based doses (in mg/kg/day) or fixed daily doses (in mg/day), and investigated the pattern of dosing using each strategy. Factors underlying observed variation in weight-based doses were investigated using linear mixed effects models. Weight-based dosing (in mg/kg/day) clustered around a small number of peaks, and all antibiotics had 1–3 standard weight-based doses used in 5%-48% of doses. Dosing strategy was more often weight-based than fixed daily dosing for all antibiotics apart from teicoplanin, which had approximately equal proportions of dosing attributable to each strategy. No strong consistent patterns emerged to explain the historical variation in actual weight-based doses used apart from higher dosing seen in central nervous system infections, and lower in skin and soft tissue infections compared to lower respiratory tract infections. Higher dosing was noted in the Americas compared to the European region. CONCLUSIONS: Antibiotic dosing in children clusters around a small number of doses, although variation remains. There is a clear opportunity for the clinical, scientific and public health communities to consolidate behind a consistent set of global antibiotic dosing guidelines to harmonise current practice and prioritise future research.
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spelling pubmed-81590112021-06-10 Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines Clements, Michelle N. Russell, Neal Bielicki, Julia A. Ellis, Sally Gastine, Silke Hsia, Yingfen Standing, Joseph F. Walker, A. Sarah Sharland, Mike PLoS One Research Article BACKGROUND: Paediatric global antibiotic guidelines are inconsistent, most likely due to the limited pharmacokinetic and efficacy data in this population. We investigated factors underlying variation in antibiotic dosing using data from five global point prevalence surveys. METHODS & FINDINGS: Data from 3,367 doses of the 16 most frequent intravenous antibiotics administered to children 1 month–12 years across 23 countries were analysed. For each antibiotic, we identified standard doses given as either weight-based doses (in mg/kg/day) or fixed daily doses (in mg/day), and investigated the pattern of dosing using each strategy. Factors underlying observed variation in weight-based doses were investigated using linear mixed effects models. Weight-based dosing (in mg/kg/day) clustered around a small number of peaks, and all antibiotics had 1–3 standard weight-based doses used in 5%-48% of doses. Dosing strategy was more often weight-based than fixed daily dosing for all antibiotics apart from teicoplanin, which had approximately equal proportions of dosing attributable to each strategy. No strong consistent patterns emerged to explain the historical variation in actual weight-based doses used apart from higher dosing seen in central nervous system infections, and lower in skin and soft tissue infections compared to lower respiratory tract infections. Higher dosing was noted in the Americas compared to the European region. CONCLUSIONS: Antibiotic dosing in children clusters around a small number of doses, although variation remains. There is a clear opportunity for the clinical, scientific and public health communities to consolidate behind a consistent set of global antibiotic dosing guidelines to harmonise current practice and prioritise future research. Public Library of Science 2021-05-27 /pmc/articles/PMC8159011/ /pubmed/34043696 http://dx.doi.org/10.1371/journal.pone.0252223 Text en © 2021 Clements et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Clements, Michelle N.
Russell, Neal
Bielicki, Julia A.
Ellis, Sally
Gastine, Silke
Hsia, Yingfen
Standing, Joseph F.
Walker, A. Sarah
Sharland, Mike
Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines
title Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines
title_full Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines
title_fullStr Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines
title_full_unstemmed Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines
title_short Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines
title_sort global antibiotic dosing strategies in hospitalised children: characterising variation and implications for harmonisation of international guidelines
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159011/
https://www.ncbi.nlm.nih.gov/pubmed/34043696
http://dx.doi.org/10.1371/journal.pone.0252223
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