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Optimized Antimicrobial Dosing Strategies: A Survey of Pediatric Hospitals

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Abstract

Background

Extended-interval aminoglycoside (EIAG) and extended- and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited.

Objective

The objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA.

Study Design, Setting, and Participants

A national survey of children’s hospitals was conducted. A single practitioner from each target hospital was identified through the Children’s Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing.

Main Outcome Measure

The main outcome measure was the percentage utilization of the dosing strategies, with secondary outcomes being the reasons for not using these dosing strategies.

Results

Seventy-seven of 215 identified practitioners (36 %) participated in the survey. EIAG, EIBL, and CIBL dosing were utilized in 63 %, 24 %, and 13 % of responding hospitals, respectively. The most common reasons for not using EIAG were concern regarding lack of efficacy data (56 %) and concern regarding the duration of the drug-free period (41 %). Respondents who did not utilize EIBL cited concern due to lack of pediatric EIBL efficacy data (54 %), the need for more intravenous access (54 %), intravenous medication compatibility issues (39 %), and the time during which the patient is attached to an intravenous infusion (31 %).

Conclusion

This survey of children’s hospitals indicates that EIAG is used in over 50 % of hospitals, but there is some lag in adoption of EIBL and CIBL dosing, both of which are used in fewer than 25 % of hospitals. Additional studies may provide much-needed evidence to increase the utilization of these strategies.

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Conflicts of interest

C.A. Knoderer, K.R. Nichols, and E.G. Fox have no potential conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave., Indianapolis, IN, 46208, USA

    Chad A. Knoderer & Kristen R. Nichols

  2. Department of Pharmacy, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

    Kristen R. Nichols

  3. Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease, Indiana University School of Medicine, Indianapolis, IN, USA

    Kristen R. Nichols & Elaine G. Cox

Authors
  1. Chad A. Knoderer
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  2. Kristen R. Nichols
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  3. Elaine G. Cox
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Correspondence to Chad A. Knoderer.

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Knoderer, C.A., Nichols, K.R. & Cox, E.G. Optimized Antimicrobial Dosing Strategies: A Survey of Pediatric Hospitals. Pediatr Drugs 16, 523–529 (2014). https://doi.org/10.1007/s40272-014-0093-1

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  • DOI: https://doi.org/10.1007/s40272-014-0093-1

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