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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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A worrying trend in weight-adjusted paediatric antibiotic use in a Norwegian tertiary care hospital

Ragnhild Raastad1,2, Ingunn Fride Tvete3, Tore G Abrahamsen2,4

  • 1Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.

Acta Paediatrica (Oslo, Norway : 1992)
|March 11, 2015
PubMed

Insights

A novel weight-adjusted method revealed increased paediatric antibiotic use in a Norwegian hospital. This approach, using recommended daily doses per 100 kg days (RDDs/kg days), offers a more accurate measure than defined daily doses (DDD) for children.

Area of Science:

  • Pediatric Pharmacology
  • Antimicrobial Stewardship
  • Hospital Pharmacy

Background:

  • The World Health Organization's defined daily dose (DDD) is standard for antibiotic measurement but unsuitable for pediatric populations.
  • Accurate assessment of pediatric antibiotic consumption is crucial for effective antimicrobial stewardship.

Purpose of the Study:

  • To evaluate pediatric antibiotic use in a Norwegian tertiary care hospital.
  • To implement and assess a novel weight-adjusted method for measuring antibiotic consumption in children.

Main Methods:

  • Antibiotic purchase and hospital admission data were collected from 2002-2009.
  • Recommended daily doses per 100 kg days (RDDs/kg days) were calculated using national guidelines, length of stay, and estimated pediatric weights.
  • Data were analyzed to compare weight-adjusted metrics with traditional defined daily doses per 100 bed days (DDD/100 bed days).

Main Results:

  • Total antibiotic use significantly increased from 51.8 to 65.5 RDDs/100 kg days over the study period.
  • Significant annual increases were observed in carbapenem (18.0%), third-generation cephalosporin (6.0%), and imidazole derivative (6.6%) consumption.
  • A notable discrepancy was found between RDDs/100 kg days and DDDs/100 bed days for neonates, highlighting the limitations of DDDs in this group.

Conclusions:

  • Weight-adjusted antibiotic use (RDDs/100 kg days) provides a more clinically relevant measure of consumption in pediatric patients, especially neonates, compared to DDDs/100 bed days.
  • Despite a low prevalence of antibiotic-resistant pathogens, overall antibiotic use and the consumption of specific agents like meropenem, third-generation cephalosporins, and imidazole derivatives showed significant increases.
Abstract

Keywords:
Antibacterial agentsDefined daily doseDrug utilisationHospitalised childrenRecommended daily dose

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