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BMC Pediatr. 2015 Apr 16;15:41. doi: 10.1186/s12887-015-0359-y.

High variability in the dosing of commonly used antibiotics revealed by a Europe-wide point prevalence study: implications for research and dissemination.

Author information

1
Institute of Microbiology, Tartu University, Tartu, Estonia. Tuuli.Metsvaht@kliinikum.ee.
2
Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia. Tuuli.Metsvaht@kliinikum.ee.
3
Institute of Microbiology, Tartu University, Tartu, Estonia. Georgi.Nellis@kliinikum.ee.
4
Children's Clinic, Tartu University Hospital, Tartu, Estonia. Georgi.Nellis@kliinikum.ee.
5
Children's Clinic, Tartu University Hospital, Tartu, Estonia. Heili.Varendi@kliinikum.ee.
6
Alder Hey Children's NHS Foundation Trust, Liverpool, UK. TNunn100@hotmail.com.
7
Research and Development, Liverpool women's NHS Foundation Trust, Liverpool, UK. Susan.Graham@lwh.nhs.uk.
8
Pharmacy Department, Hospital Antoine Beclère, Paris, France. Andre.Rieutord@abc.aphp.fr.
9
Pharmacy Department, APHP, Hospital Robert Debré, Paris, France. Thomas.Storme@rdb.aphp.fr.
10
Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK. J.Mcelnay@qub.ac.uk.
11
Department of Pharmacy, University Hospitals of Leicester, Leicester, UK. Hussain.Mulla@uhl-tr.nhs.uk.
12
Department of Women's and Children's Health, Institute of Translational Medicine, Liverpool Women's NHS Foundation Trust, University of Liverpool, Liverpool, UK. Mark.Turner@liverpool.ac.uk.
13
Institute of Microbiology, Tartu University, Tartu, Estonia. Irja.Lutsar@ut.ee.

Abstract

BACKGROUND:

Antibiotic dosing in neonates varies between countries and centres, suggesting suboptimal exposures for some neonates. We aimed to describe variations and factors influencing the variability in the dosing of frequently used antibiotics in European NICUs to help define strategies for improvement.

METHODS:

A sub-analysis of the European Study of Neonatal Exposure to Excipients point prevalence study was undertaken. Demographic data of neonates receiving any antibiotic on the study day within one of three two-week periods from January to June 2012, the dose, dosing interval and route of administration of each prescription were recorded. The British National Formulary for Children (BNFC) and Neofax were used as reference sources. Risk factors for deviations exceeding ±25% of the relevant BNFC dosage recommendation were identified by multivariate logistic regression analysis.

RESULTS:

In 89 NICUs from 21 countries, 586 antibiotic prescriptions for 342 infants were reported. The twelve most frequently used antibiotics - gentamicin, penicillin G, ampicillin, vancomycin, amikacin, cefotaxime, ceftazidime, meropenem, amoxicillin, metronidazole, teicoplanin and flucloxacillin - covered 92% of systemic prescriptions. Glycopeptide class, GA <32 weeks, 5(th) minute Apgar score <5 and geographical region were associated with deviation from the BNFC dosage recommendation. While the doses of penicillins exceeded recommendations, antibiotics with safety concerns followed (gentamicin) or were dosed below (vancomycin) recommendations.

CONCLUSIONS:

The current lack of compliance with existing dosing recommendations for neonates needs to be overcome through the conduct of well-designed clinical trials with a limited number of antibiotics to define pharmacokinetics/pharmacodynamics, efficacy and safety in this population and by efficient dissemination of the results.

PMID:
25880733
PMCID:
PMC4407781
DOI:
10.1186/s12887-015-0359-y
[Indexed for MEDLINE]
Free PMC Article

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