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Aminoglycoside prescription: compliance with national guidelines in a pediatric hospital
S Manen1, C Bost-Bru2, I Wroblewski1
1Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, 38000 Grenoble, France.
Insights
Aminoglycoside use in children in acute care settings shows significant non-compliance with national guidelines. Optimizing dosing and monitoring in pediatric intensive care units and refining initiation criteria in emergency departments are crucial for efficacy and to combat drug resistance.
Area of Science:
- Pediatric Pharmacology
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Aminoglycosides (AGs) are critical antibiotics in pediatric acute care.
- Adherence to national recommendations for AG use is essential for optimal outcomes and antimicrobial stewardship.
Purpose of the Study:
- To evaluate the current utilization patterns of aminoglycosides in pediatric patients within acute care settings.
- To assess the compliance of AG prescriptions with the latest French national guidelines.
Main Methods:
- A single-center retrospective study was conducted over five months.
- Included pediatric patients receiving at least one dose of AGs in emergency or intensive care units.
- Compliance with 2011 French recommendations was evaluated.
Main Results:
- 153 AG prescriptions for 139 pediatric patients were analyzed (gentamicin and amikacin).
- Compliance with national guidelines was observed in only 50% of prescriptions.
- Misuse included inappropriate indications in emergency departments and underdosing/lack of monitoring in pediatric intensive care units.
Conclusions:
- Aminoglycoside prescribing in pediatric acute care settings requires improvement.
- Higher doses and consistent therapeutic drug monitoring are recommended, especially in pediatric intensive care units.
- Clearer criteria for initiating AGs are needed in emergency departments to ensure appropriate use and combat resistance.
Objective:
Our study aimed to describe the use of aminoglycosides (AGs) in the pediatric population in acute settings and to assess its compliance with the most recent national recommendations.
Methods:
A single-center retrospective study conducted over a 5-month period. Pediatric patients who received at least one dose of AGs in emergency or intensive care unit were included. Compliance with the 2011 French recommendations was assessed.
Results:
A total of 153 AG prescriptions (120 with gentamicin and 33 with amikacin) for 139 patients (median age of patients = 10 months [IQR: 3-36]) were analyzed. Most of the AG prescriptions were initiated in the emergency department (n = 117, 76%) and, overall, compliance with national guidelines was met in half (n = 77) of the prescriptions. In the emergency department, cases of misuse concerned the indication, mostly for patients with pyelonephritis. In the pediatric intensive care unit setting, the misuse concerned underdosing and a low rate of pharmacological monitoring.
Conclusion:
AGs are still misused in pediatric acute settings. In order to limit drug resistance and to be more efficacious, higher doses should be used and monitoring should be performed, in particular in pediatric intensive care units. In the emergency department, more objective criteria should be used to initiate AGs.
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