A National Survey of Antimicrobial Dosing Strategies at Pediatric Institutions

INTRODUCTION: Extended-interval aminoglycoside (EIAG) and extended-infusion beta-lactam (EIBL) dosages are examples of dosage strategies that can optimize antibiotics’ pharmacokinetic and pharmacodynamic properties. Optimizing the way in which antimicrobial doses are given is consistent with the general goals of antimicrobial stewardship programs and could further positively impact patient care. The widespread adoption of these dosage strategies in children has lagged behind that in adults, and the current prevalence of these dosage strategies in pediatric patients is unknown. The objective of this study was to describe the use of EIAG and EIBL dosages in national pediatric hospitals.

METHODS: A national survey of children’s hospitals was conducted using SurveyMonkey (SurveyMonkey. com). A single practitioner from each target hospital was identified through the Children’s Hospital Association. Following initial survey administration, the survey remained open for 6 weeks, and follow-up reminders were sent at weeks 2 and 4. Demographic questions queried presence of an antimicrobial stewardship program, infectious diseases physician specialists, institution size, and geographic location. Practice-based survey questions identified whether institutions were utilizing EIAG, EIBL, and/or continuous infusion penicillin dosage. Reasons cited for not using these dosage strategies were also questioned.

RESULTS: The survey was administered to 215 identified practitioners with 77 participating, for a 36% response rate. The majority of respondents were clinical pharmacists (79.2%), and the hospital being considered was a teaching hospital (93.5%). EIBL and continuous infusion penicillin antibiotics were used by 61% (n = 47), 21% (n = 16), and 10% (n = 8) of responding institutions, respectively. The most common reasons for not using EIA were concern regarding lack of efficacy data (56%) and concern for the duration of drug-free period (41%). Respondents who responded they did not use EIBL indicated concern due to lack of pediatric EIBL efficacy data (54%), need for more intravenous (IV) access (54%), IV medication compatibility issues (39%),

time patient is attached to an IV infusion (30%), and lack of resistance at the individual’s institutions (25%). The most common reason for not using continuous penicillin, including nafcillin, was the prolonged time a patient would be attached to the IV infusion (55%).

CONCLUSIONS: This national survey of children’s hospitals indicated that the optimized dosage strategy of EIAG is used in over 50% of institutions but that the EIBL and continuous infusion penicillin dosage strategies are used in less than 25%. Documented concerns for their use suggest that there are opportunities for further education and clarification of the available clinical evidence supporting the use of these strategies. Additional studies regarding EIBL and continuous penicillin administration may result in increased adoption of these strategies.