Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines.
Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines.
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DOI：
10.1371/journal.pone.0252223
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Sharland M
中科院分区：
文献类型：
--
作者：
Clements MN;Russell N;Bielicki JA;Ellis S;Gastine S;Hsia Y;Standing JF;Walker AS;Sharland M
儿科全球抗生素指南不一致，最可能是由于该人群的药代动力学和疗效数据有限。我们使用来自五个全球点患病率调查的数据调查了抗生素剂量变化的潜在因素。分析了23个国家1个月至12岁儿童使用的16种最常见静脉注射抗生素的3，367剂数据。对于每种抗生素，我们将标准剂量确定为基于体重的剂量（mg/kg/天）或固定的每日剂量（mg/天），并研究了使用每种策略的给药模式。使用线性混合效应模型研究了观察到的基于体重的剂量变化的潜在因素。基于体重的给药（mg/kg/天）聚集在少数峰周围，所有抗生素均在5%-48%的剂量中使用了1-3个基于体重的标准剂量。除替考拉宁外，所有抗生素的给药策略通常基于体重，而不是固定每日给药，每种策略的给药比例大致相等。除了中枢神经系统感染中观察到的剂量较高以及与下呼吸道感染相比皮肤和软组织感染中的剂量较低外，未出现强一致的模式来解释实际使用的基于体重的剂量的历史变化。与欧洲地区相比，在美洲观察到更高的剂量。儿童的抗生素剂量集中在少数剂量上，尽管仍然存在差异。临床、科学和公共卫生界有一个明确的机会来巩固一套一致的全球抗生素剂量指南，以协调当前的实践并优先考虑未来的研究。
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. 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. 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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影响因子：
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