β-lactam precision dosing in critically ill children: Current state and knowledge gaps

Area of Science:

• Pediatric Critical Care Medicine
• Pharmacology and Therapeutics
• Infectious Diseases

Background:

• Growing interest exists in therapeutic drug monitoring and model-informed precision dosing for beta-lactam antibiotics in critically ill patients, including children.
• A position paper supports these efforts in critically ill adults, yet widespread adoption in pediatric populations remains limited.
• Understanding beta-lactam pharmacokinetics and pharmacodynamics in critically ill children is crucial for optimizing treatment.

Purpose of the Study:

• To review current knowledge on beta-lactam antibiotic pharmacokinetics and pharmacodynamics in critically ill children.
• To identify knowledge gaps hindering the acceptance and implementation of precision dosing strategies in this patient group.
• To highlight areas for future research to facilitate the adoption of precision dosing.

Main Methods:

• Literature review focusing on pharmacokinetic and pharmacodynamic data of beta-lactam antibiotics in critically ill children.
• Analysis of existing guidelines and position papers regarding therapeutic drug monitoring.
• Identification and definition of knowledge gaps and barriers to implementation.

Main Results:

• Current understanding of beta-lactam pharmacokinetics and pharmacodynamics in critically ill children is summarized.
• Key knowledge gaps include lack of consensus on specific subpopulations benefiting most from precision dosing.
• Uncertainty regarding the impact of precision dosing on clinical outcomes in pediatric critical care is a significant barrier.

Conclusions:

• Implementation of precision dosing for beta-lactam antibiotics in critically ill children requires addressing identified knowledge gaps.
• Further research is essential to establish consensus on target populations and demonstrate improved patient outcomes.
• Closing these knowledge gaps will support the wider adoption of evidence-based precision dosing strategies.