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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

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Agreement between units of measure for paediatric antibiotic utilisation surveillance using hospital pharmacy supply

Mona Mostaghim1, Tom Snelling2, Beata Bajorek3

  • 1Pharmacy Department, Sydney Children's Hospital; & Graduate School of Health, University of Technology Sydney, NSW (Australia). mona.mostaghim@health.nsw.gov.au.

Pharmacy Practice
|October 9, 2019
PubMed

Insights

Standard adult defined daily doses (DDD) show agreement with vial-based measures for paediatric antibiotic use. This supports DDD for antimicrobial stewardship in hospitals lacking patient-level data.

Area of Science:

  • Pharmacology
  • Paediatric Intensive Care
  • Antimicrobial Stewardship

Background:

  • Paediatric drug utilization studies are challenged by a lack of standardized units for varying patient dosage needs.
  • The World Health Organization's defined daily dose (DDD) is standard for adults but not recommended for children.

Purpose of the Study:

  • To assess agreement between adult-based DDD and paediatric estimates of injectable antibiotic use in a Paediatric Intensive Care Unit.
  • To evaluate measurement units for antibiotic consumption in paediatric settings without patient-level data.

Main Methods:

  • Extracted hospital pharmacy antibiotic use and bed-day data (2010-2016).
  • Defined paediatric reference dosages and applied them to three units of measure.
  • Assessed agreement between adult DDD and paediatric measures using Bland-Altman plots and linear regression.

Main Results:

  • Thirty-one antibiotics were analyzed.
  • Vial use remained consistent across age groups for 13 antibiotics, despite dosage variations.
  • Vial-based measures showed closer agreement with DDD than total recommended doses, accounting for wastage and unaffected by vial size changes.

Conclusions:

  • Agreement between DDD and vial-based measures supports DDD use for select antibiotics in stewardship programs.
  • Vial-based measures warrant further investigation, especially in single-vial policies.
  • Understanding hospital practices is crucial for accurate inter-hospital comparisons.
Abstract

Keywords:
Anti-Bacterial AgentsAntimicrobial StewardshipAustraliaDrug UtilizationHospitalHospitalsPediatricPharmacy ServiceQuality of Health CareReference StandardsRetrospective Studies

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