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Dose optimisation of antibiotics in children: application of pharmacokinetics/pharmacodynamics in paediatrics
Affiliation:1. Division of Infectious Diseases, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;2. Division of Neonatology, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;3. Department of Pharmacy, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;4. Division of Clinical Pharmacology, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;5. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA;1. Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden;2. Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden;3. Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, SE-901 87, Umeå, Sweden;4. Sustainable Pharmaceutical Systems (SPS) Unit, Department of Pharmacy, School of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda;5. Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden;1. Division of Gastroenterology, Department of Medicine, University of Colorado Denver, Aurora, Colorado;2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;3. Division of Rheumatology, Nemours A.I. duPont Hospital for Children, Wilmington, Delaware;4. Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey;5. Division of Gastroenterology, Department of Medicine and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;6. Abramson Cancer Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;7. Department of Gastroenterology, Seattle Children''s Hospital, Seattle, Washington;1. Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia;2. Royal Brisbane and Women''s Hospital, Brisbane, Queensland, Australia;3. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia;4. School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia;1. Swiss Tropical and Public Health Institute, Basel, Switzerland;2. Department of Epidemiology and Public Health University of Basel, Basel, Switzerland;3. Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland;4. Department of Global Health and Population and Harvard TH Chan School of Public Health, Boston, MA, USA
Abstract:
The judicious use of antibiotics to combat infections in children relies upon appropriate selection of an agent, dose and duration to maximise efficacy and to minimise toxicity. Critical to dose optimisation is an understanding of the pharmacokinetics and pharmacodynamics of available drugs. Optimal dosing strategies may take advantage of pharmacokinetic/pharmacodynamic (PK/PD) principles so that antibiotic dosing can be individualised to assure effective bacterial killing in patients who have altered pharmacokinetics or who have infections with less susceptible or resistant organisms. This review will outline the fundamentals of antimicrobial pharmacokinetics/pharmacodynamics through discussion of antibacterial agents most often used in children. We aim to highlight the importance of dose optimisation in paediatrics and describe non-conventional dosing strategies that can take advantage of PK/PD principles at the bedside.
Keywords:Dose optimisation  Pharmacokinetics  Pharmacodynamics  PK/PD  Antibiotics
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