Comparing neonatal and paediatric antibiotic prescribing between hospitals: a new algorithm to help international benchmarking

Porta, Alessandro; Hsia, Yingfen; Doerholt, Katja; Spyridis, Νikos; Bielicki, Julia; Menson, Esse; Τσολιά, Μαρία; Esposito, Susanna; Wong, Ian C. K.; Sharland, Mike

doi:10.1093/jac/dks021

Cited by 67 publications

(72 citation statements)

References 14 publications

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“…In UK survey, 24 different combinations of dose were revealed and the dosing interval varied markedly from 12 to 48 h. In a French survey, we found 25 different combinations of doses and the dosing interval varied from 8 to 48 h. For vancomycin, clinical practice is even more variable in France, as both of continuous infusion and intermittent infusion were routinely used. Our results are also consistent with the previous findings by Porta et al 39 who reported wide variation between four children's hospitals in the type and dose of antibiotic used in paediatrics based on daily prescription data.…”

Section: Discussionsupporting

confidence: 93%

Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based: a French national survey

et al. 2015

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International audienceOBJECTIVE: This survey aims to describe and analyse the dosage regimens of antibiotics in French neonatal intensive care units (NICUs). METHODS: Senior doctors from 56 French NICUs were contacted by telephone and/or email to provide their local guidelines for antibiotic therapy. RESULTS: 44 (79%) NICUs agreed to participate in this survey. In total, 444 dosage regimens were identified in French NICUs for 41 antibiotics. The number of different dosage regimens varied from 1 to 32 per drug (mean 9, SD 7.8). 37% of intravenous dosage regimens used a unique mg/kg dose from preterm to full-term neonates. Doses and/or dosing intervals varied significantly for 12 antibiotics (amikacin, gentamicin, netilmicin, tobramycin, vancomycin administered as continuous infusion, ceftazidime, cloxacillin, oxacillin, penicillin G, imipenem/cilastatin, clindamycin and metronidazole). Among these antibiotics, 6 were used in more than 70% of local guidelines and had significant variations in (1) maintenance daily doses for amikacin, imipenem/cilastatin, ceftazidime and metronidazole; (2) loading doses for continuous infusion of vancomycin; and (3) dosing intervals for gentamicin and amikacin. CONCLUSIONS: A considerable inter-centre variability of dosage regimens of antibiotics exists in French NICUs. Developmental pharmacokinetic-pharmacodynamic studies are essential for the evaluation of antibiotics in order to establish evidence-based dosage regimens for effective and safe administration in neonates

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Section: Discussionsupporting

confidence: 93%

Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based: a French national survey

et al. 2015

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“…Currently, the WHO does not, however, recommend the use of DDDs as measurement in children, but in practice this approach is commonly used since more accurate methods are not available 30. Thus, there are no generally accepted DDDs for children, although some studies have suggested possible DDDs for different ages of children 31 32…”

Section: Discussionmentioning

confidence: 99%

“…One possible way of producing such data would be based on the weight of individual patients. The study by Porta et al 31 (European ARPEC project) suggested age-appropriate DDDs for antibiotics especially for neonates. On the other hand, some studies suggest that adult DDDs in paediatrics may be equal with PDDs or higher 13 14…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial consumption in a tertiary children’s hospital in Finland (2003–2013)

et al. 2016

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Background Numbers of resistant pathogens are constantly increasing, and prudent use of antimicrobials is of paramount importance. In order to see whether any changes in the use of antimicrobials in recent years have occurred, we decided to monitor the consumption of these drugs at a single tertiary paediatric hospital. Materials and methods This single-centre retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical /DDD index) in a 130-bed paediatric tertiary hospital. The data on the consumption of antimicrobials were collected from years 2003-2013 by using electronic surveillance records provided by the local pharmacy. The consumption was related to days of hospital care. Results During 2003-2013, the use of penicillins, cephalosporins and carbapenems increased by 28%, 46% and 110%, respectively. The consumption of both aminoglycosides and vancomycin decreased by 61% and 41%, respectively. Amphotericin B use clearly decreased by 39% while the use of novel azoles and echinocandins increased. Conclusions Increased use of carbapenems was the most significant finding of our study. The year-to-year consumption of antibacterials was in general relatively stable and new antibacterials were taken into use conservatively. In contrast to antibacterials, novel antifungals were rapidly adopted into use despite scarce evidence on their safety in children. INTRODUCTIONInvestigating and monitoring the consumption of antimicrobials in hospitals is necessary in order to encourage prudent use of these drugs. The use of broad spectrum antibacterials is a potential problem. It causes selection pressure and may lead to increasing numbers of resistant pathogens. In addition, such use of antibacterials most probably also causes difficult secondary infections. Similarly, local knowledge on the use of antimicrobials is crucial and allows us to implement necessary measures to support appropriate use of antimicrobials.When investigating the consumption of antimicrobials, defined daily doses (DDDs) can be used. DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.3 4 Numerous studies have investigated the consumption of antimicrobials in hospitalised adult patients by using DDDs, 5-8 but such studies in paediatric patients are in large scale missing.There are obvious obstacles when using DDDs in children. The most important being that the paediatric population is a very heterogeneous group with great variation in weight and age. Thus, comparing neonatal use with that of the adolescents is very challenging. The DDDs may, however, be used to describe paediatric consumption of individual antimicrobials over a certain period of time in a setting where no major changes in the hospital clientele took place.We have studied the consumption of these drugs in the Children's Hospital, University of Helsinki, by using DDDs as parameters of antibiotic use. The overall age bands of our patients have stayed...

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“…Die Angabe von DDD/RDD (Defined Daily Doses/Recommended Daily Doses) sind für den Bereich der pädiatrischen Medizin nicht möglich -verschiedene alternative Vergleichsmöglichkeiten des Antibiotikaverbrauchs zwischen pädiatrischen Kliniken werden zurzeit untersucht. [ 17 ] . Diese alternativen Konzepte basieren auf der Erfassung des Antiinfektivaverbrauchs in verschiedenen pädiatrischen Gewichtsklassen [ 17 ] oder "Days of Therapy (DOT)", also Antiinfektivatherapietage für eine spezifi sche Substanz pro 100 stationäre Behandlungstage [ 26 ] .…”

Section: ▼ Klinische Einrichtung Und Eckdatenunclassified

“…[ 17 ] . Diese alternativen Konzepte basieren auf der Erfassung des Antiinfektivaverbrauchs in verschiedenen pädiatrischen Gewichtsklassen [ 17 ] oder "Days of Therapy (DOT)", also Antiinfektivatherapietage für eine spezifi sche Substanz pro 100 stationäre Behandlungstage [ 26 ] . …”

Section: ▼ Klinische Einrichtung Und Eckdatenunclassified

Pilotprojekt einer pädiatrischen Antibiotic-Stewardship-Initiative am Dr. von Haunerschen Kinderspital - neue Wege der pädiatrischen Infektiologie

et al. 2013

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The steady increase in antimicrobial resistance is of growing concern in healthcare. Antibiotic Stewardship [ABS] Strategies are important tools to control antibiotic use and -prevent antimicrobial resistance. An increasing number of institutions are developing ABS initiatives also in pediatrics. However, few data are available assessing the implementation and efficiency of these pediatric ABS programs.At the Dr. von Hauner Children's Hospital, Ludwig-Maximilian University, a tertiary care pediatric reference center, a pediatric ABS Team has been implemented. Key structural elements were the same as for adult patients, but antimicrobials agents selected for monitoring and appropriate clinical endpoints are different in pediatrics.Key features were: 1. prospective-audit with feedback and formulary restriction and 2. pre-authorization (also referred to as prior approval). The ABS team consisted of one pediatric infectious disease specialist, one clinical fellow in pediatric infectious diseases, and one clinical pharmacist with training in infectious diseases.With the implementation of a pediatric ABS strategy we could significantly influence antimicrobial consumption in our hospital. Cost-savings are estimated to be above 330 000 € per year, and concomitantly the use of broad-spectrum antibiotics and antifungal compounds was significantly reduced.Antibiotic Stewardship [ABS] Strategies may be an effective tool to control antibiotic use in the setting of a large tertiary pediatric teaching hospital. A national guideline for ABS initiatives may help to further improve rational use of antibiotics in the hospital setting.

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Comparing neonatal and paediatric antibiotic prescribing between hospitals: a new algorithm to help international benchmarking

Abstract: This novel method has the potential to be a useful tool to provide antibiotic use comparator data and requires validation in a large prospective point prevalence study.

Cited by 67 publications

References 14 publications

Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based: a French national survey

Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based: a French national survey

Antimicrobial consumption in a tertiary children’s hospital in Finland (2003–2013)

Pilotprojekt einer pädiatrischen Antibiotic-Stewardship-Initiative am Dr. von Haunerschen Kinderspital - neue Wege der pädiatrischen Infektiologie

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