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
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DOI：
10.1136/archdischild-2014-306873
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发表时间：
2015-04-01
影响因子：
5.2
通讯作者：
Jacqz-Aigrain, Evelyne
中科院分区：
文献类型：
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作者：
Leroux, Stephanie;Zhao, Wei;Jacqz-Aigrain, Evelyne
目的了解法国新生儿重症监护病房（NICU）抗生素的使用情况，为制定合理的抗生素使用方案提供依据。方法通过电话和/或电子邮件的方式联系56家NICU的高级医生，提供当地的抗生素使用指南。法国NICU共确定了41种抗生素的444种给药方案。每种药物的不同给药方案的数量从1到32不等（平均值9，SD 7.8）。37%的静脉给药方案从早产儿到足月新生儿使用独特的mg/kg剂量。12种抗生素（阿米卡星、庆大霉素、奈替米星、妥布霉素、持续输注万古霉素、头孢他啶、氯唑西林、苯唑西林、青霉素G、亚胺培南/西司他丁、克林霉素和甲硝唑）的剂量和/或给药间隔差异显著。在这些抗生素中，有6个使用超过70%的地方指南，并有显着的变化（1）阿米卡星，亚胺培南/西司他丁，头孢他啶和甲硝唑的维持日剂量;（2）负荷剂量连续输注万古霉素;和（3）给药间隔庆大霉素和阿米卡星。结论相当大的中心间变异的抗生素的剂量方案存在于法国新生儿重症监护病房。开发药代动力学-药效学研究对于评价抗生素以建立新生儿有效和安全给药的循证给药方案至关重要。
Objective 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.