Related Experiment Video
Updated: Feb 19, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
β-lactam Therapeutic Drug Management in the PICU
Jeffrey J Cies, Wayne S Moore1, Adela Enache2
1The Center for Pediatric Pharmacotherapy LLC, Pottstown, PA.
Insights
Critically ill children often receive subtherapeutic beta-lactam antibiotic doses. Therapeutic drug management improved outcomes, suggesting a need for optimized dosing in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric critical care medicine
- Pharmacology and pharmacokinetics
- Infectious disease management
Background:
- Current beta-lactam anti-infective dosing recommendations in critically ill children may not achieve maximal anti-infective activity.
- Optimizing drug concentrations is crucial for effective treatment of serious infections in pediatric patients.
Purpose of the Study:
- To evaluate if current beta-lactam dosing guidelines in pediatric intensive care units (PICUs) achieve therapeutic concentrations.
- To assess microbiological and clinical outcomes associated with beta-lactam therapeutic drug management in critically ill children.
Main Methods:
- Retrospective electronic medical record review of patients in a pediatric tertiary care hospital.
- Analysis of beta-lactam therapeutic drug management data from 82 patients in the PICU between 2014 and 2017.
- Inclusion criteria: sepsis or extracorporeal therapy requiring beta-lactam management.
Main Results:
- 95% of patients had subtherapeutic anti-infective concentrations, failing to meet pharmacodynamic targets.
- Despite subtherapeutic levels, all infected patients achieved microbiological response.
- 95.7% of infected patients experienced a positive clinical response with therapeutic drug management.
Conclusions:
- Current pediatric beta-lactam dosing recommendations are frequently inadequate for critically ill children.
- Beta-lactam therapeutic drug management is a valuable strategy to optimize drug exposure and improve patient outcomes.
- Further research is needed to refine dosing and assess outcomes in larger pediatric cohorts.
Objectives:
To determine whether contemporary β-lactam anti-infective dosing recommendations in critically ill children achieve concentrations associated with maximal anti-infective activity. The secondary objective was to describe the microbiological and clinical outcomes associated with β-lactam therapeutic drug management.
Design:
Electronic Medical Record Review.
Setting:
A 189-bed, freestanding children's tertiary care teaching hospital in Philadelphia, PA.
Patients:
Patients admitted to the PICU from September 1, 2014, to May 31, 2017, with sepsis and those receiving extracorporal therapy with either extracorporeal membrane oxygenation or continuous renal replacement therapy that had routine β-lactam therapeutic drug management.
Interventions:
None.
Measurements And Main Results:
Eighty-two patients were in the total cohort and 23 patients in the infected cohort accounting for 248 samples for therapeutic drug management analysis. The median age was 1 year (range, 4 d to 18 yr) with a mean weight of 19.7 ± 22.3 kg (range, 2.7-116 kg). Twenty-three patients (28%) had growth of an identified pathogen from a normally sterile site. Seventy-eight of 82 patients (95%) had subtherapeutic anti-infective concentrations and did not attain the primary pharmacodynamic endpoint. All patients in the infected cohort achieved a microbiological response, and 22 of 23 (95.7%) had a positive clinical response.
Conclusions:
Overall, 95% of patients had subtherapeutic anti-infective concentrations and did not achieve the requisite pharmacodynamic exposure with current pediatric dosing recommendations. All patients achieved a microbiological response, and 95.7% achieved clinical response with active β-lactam therapeutic drug management. These data suggest β-lactam therapeutic drug management is a potentially valuable intervention to optimize anti-infective pharmacokinetics and the pharmacodynamic exposure. Further, these data also suggest the need for additional research in specific pediatric populations and assessing clinical outcomes associated with β-lactam therapeutic drug management in a larger cohort of pediatric patients.
More Related Videos
06:18Quantifying the Effects of Antimicrobials on In vitro Biofilm Architecture using COMSTAT Software
Published on: December 14, 2020
09:17A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii
Published on: January 2, 2017
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:29Drug Dosing: Infants and Children