Related Experiment Video
Updated: Jun 23, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Drug use density in critically ill children and newborns: analysis of various methodologies
Karl Valcourt1, Faraz Norozian, Helen Lee
1Division of Critical Care Medicine, Miami Children's Hospital, Miami, FL, USA.
Insights
Assessing vancomycin and linezolid drug use density in pediatric intensive care units revealed significant differences. The number of days of drug use method is the simplest and most accurate for comparing drug use across units.
Area of Science:
- Pediatric critical care medicine
- Infectious disease pharmacotherapy
- Drug utilization research
Background:
- Accurate assessment of antibiotic use density is crucial for antimicrobial stewardship in intensive care settings.
- Vancomycin and linezolid are critical antibiotics used in pediatric, cardiac, and neonatal intensive care units (ICUs).
- Comparing different methods for calculating drug use density is essential for reliable data interpretation.
Purpose of the Study:
- To compare three methods for assessing vancomycin and linezolid drug use density in pediatric, cardiac, and neonatal ICUs.
- Methods compared include defined daily doses (DDDs), prescribed daily doses, and days of drug use per 100 patient days.
- To determine the most appropriate and accurate method for evaluating antibiotic use density in pediatric critical care.
Main Methods:
- Retrospective study conducted at a tertiary care children's hospital.
- Patient data from cardiac and neonatal ICUs (2005) and pediatric ICUs (2004-2005) treated with vancomycin or linezolid were reviewed.
- Drug use density was calculated using DDDs, prescribed daily doses, and days of drug use per 100 patient days.
Main Results:
- Vancomycin use densities varied significantly among the three ICUs when assessed by all three methods.
- Drug use densities, particularly for vancomycin, were lower when expressed as DDDs per 100 patient days.
- A significant decrease in vancomycin drug use density was observed in the pediatric ICU in 2005 compared to 2004 across all assessment methods.
Conclusions:
- The defined daily dose (DDD) method underestimates vancomycin drug use density compared to the prescribed daily dose method in critically ill children.
- The number of days of drug use method is identified as the simplest and most accurate approach for assessing and comparing drug use density.
- This method facilitates reliable comparisons of antibiotic utilization across different pediatric facilities and clinical units, aiding antimicrobial stewardship efforts.
Objective:
To compare in the pediatric, cardiac, and neonatal intensive care units, three methods of assessing vancomycin and linezolid drug use density by number of: defined daily doses (DDDs), prescribed daily doses, and days of drug use per 100 patient days.
Design:
Retrospective study.
Setting:
A tertiary care children's hospital.
Patients:
We reviewed the charts of patients admitted to the cardiac intensive care unit and neonatal intensive care unit in 2005 who were treated with vancomycin, and those admitted to the pediatric intensive care unit who were treated with vancomycin or linezolid during 2004 and 2005.
Interventions:
None.
Measurements And Main Results:
The number of patients, treatment days, total amount of vancomycin/linezolid, total intensive care unit admissions, and patient days were recorded. We used the World Health Organization definition of DDD for vancomycin and linezolid (2000 and 1200 mg, respectively). The prescribed daily dose for each intensive care unit was calculated for each year by dividing the total amount of the medication administered by the total number of treatment days. The drug use densities were then calculated as the total DDDs, prescribed daily doses, and days of drug use per 100 patient days. The vancomycin use densities were significantly different among the three intensive care units when compared by each method. They were significantly lower in all three units when expressed as DDDs per 100 patient days. The vancomycin drug use density in the pediatric intensive care unit was significantly decreased during 2005 compared with 2004 by all three methods.
Conclusions:
In critically ill children, drug use density of vancomycin is significantly less when evaluated by the DDD method compared with the prescribed daily dose method, a more appropriate method in children. However, the simplest and most accurate method of assessing drug use density is the number of days of drug use method, which allows comparison of drug use density between different pediatric facilities or clinical units.
Related Concept Videos
01:29Drug Dosing: Infants and Children
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:21Factors Affecting Drug Response: Overview
01:23Drug Concentrations: Measurements
Plasma —...