Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study

Area of Science:

• Pediatric Pharmacology
• Antimicrobial Stewardship
• Drug Utilization Studies

Background:

• Fluoroquinolones (FQ) are increasingly prescribed for pediatric patients, often for indications not approved by regulatory agencies.
• Limited data exists on the appropriateness of systemic FQ use and dosing in hospitalized children.
• This study addresses the gap in understanding FQ prescribing patterns and dosing accuracy in a pediatric population.

Purpose of the Study:

• To analyze the indications for systemic fluoroquinolone (FQ) prescriptions in hospitalized children.
• To evaluate the appropriateness of prescribed FQ doses in pediatric patients.
• To identify risk factors associated with inadequate FQ dosing in children.

Main Methods:

• Retrospective drug utilization study conducted in two Belgian university children's hospitals (2010-2013).
• Inclusion of all hospitalized children receiving systemic FQ prescriptions.
• Analysis of prescription data, indications, and prescribed daily doses; logistic regression used to identify dosing error risk factors.

Main Results:

• 262 FQ prescriptions analyzed; 16.8% for labeled indications, 35.1% guided by bacteriological findings.
• 30.2% of FQ prescriptions had inappropriate doses, with underdosing being the most common error (56.9% of errors).
• Infants and preschool children showed significantly higher risk for dosing errors (adjusted ORs < 0.6).

Conclusions:

• Systemic fluoroquinolone (FQ) prescriptions in children are frequently off-label and not guided by microbiological data.
• Dosing errors, particularly underdosing, are common in pediatric FQ use, especially in younger children.
• Improved pediatric antimicrobial stewardship and further pharmacokinetic research are crucial for optimizing FQ dosing in children.