Optimized Antimicrobial Dosing Strategies: A Survey of Pediatric Hospitals

<p> <h3> Background </h3></p><p> Extended-interval aminoglycoside (EIAG) and extended- and continuous-infusion &beta;-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited. <h3> Objective </h3></p><p> The objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA. <h3> Study Design, Setting, and Participants </h3></p><p> A national survey of children&rsquo;s hospitals was conducted. A single practitioner from each target hospital was identified through the Children&rsquo;s Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing. <h3> Main Outcome Measure </h3></p><p> The main outcome measure was the percentage utilization of the dosing strategies, with secondary outcomes being the reasons for not using these dosing strategies. <h3> Results </h3></p><p> Seventy-seven of 215 identified practitioners (36 %) participated in the survey. EIAG, EIBL, and CIBL dosing were utilized in 63 %, 24 %, and 13 % of responding hospitals, respectively. The most common reasons for not using EIAG were concern regarding lack of efficacy data (56 %) and concern regarding the duration of the drug-free period (41 %). Respondents who did not utilize EIBL cited concern due to lack of pediatric EIBL efficacy data (54 %), the need for more intravenous access (54 %), intravenous medication compatibility issues (39 %), and the time during which the patient is attached to an intravenous infusion (31 %). <h3> Conclusion </h3></p><p> This survey of children&rsquo;s hospitals indicates that EIAG is used in over 50 % of hospitals, but there is some lag in adoption of EIBL and CIBL dosing, both of which are used in fewer than 25 % of hospitals. Additional studies may provide much-needed evidence to increase the utilization of these strategies.</p>