PDF(Pubmed)
Abstract：
Paediatric global antibiotic guidelines are inconsistent, most likely due to the limited pharmacokinetic and efficacy data in this population. We investigated factors underlying variation in antibiotic dosing using data from five global point prevalence surveys.
Data from 3,367 doses of the 16 most frequent intravenous antibiotics administered to children 1 month-12 years across 23 countries were analysed. For each antibiotic, we identified standard doses given as either weight-based doses (in mg/kg/day) or fixed daily doses (in mg/day), and investigated the pattern of dosing using each strategy. Factors underlying observed variation in weight-based doses were investigated using linear mixed effects models. Weight-based dosing (in mg/kg/day) clustered around a small number of peaks, and all antibiotics had 1-3 standard weight-based doses used in 5%-48% of doses. Dosing strategy was more often weight-based than fixed daily dosing for all antibiotics apart from teicoplanin, which had approximately equal proportions of dosing attributable to each strategy. No strong consistent patterns emerged to explain the historical variation in actual weight-based doses used apart from higher dosing seen in central nervous system infections, and lower in skin and soft tissue infections compared to lower respiratory tract infections. Higher dosing was noted in the Americas compared to the European region.
Antibiotic dosing in children clusters around a small number of doses, although variation remains. There is a clear opportunity for the clinical, scientific and public health communities to consolidate behind a consistent set of global antibiotic dosing guidelines to harmonise current practice and prioritise future research.
Data from 3,367 doses of the 16 most frequent intravenous antibiotics administered to children 1 month-12 years across 23 countries were analysed. For each antibiotic, we identified standard doses given as either weight-based doses (in mg/kg/day) or fixed daily doses (in mg/day), and investigated the pattern of dosing using each strategy. Factors underlying observed variation in weight-based doses were investigated using linear mixed effects models. Weight-based dosing (in mg/kg/day) clustered around a small number of peaks, and all antibiotics had 1-3 standard weight-based doses used in 5%-48% of doses. Dosing strategy was more often weight-based than fixed daily dosing for all antibiotics apart from teicoplanin, which had approximately equal proportions of dosing attributable to each strategy. No strong consistent patterns emerged to explain the historical variation in actual weight-based doses used apart from higher dosing seen in central nervous system infections, and lower in skin and soft tissue infections compared to lower respiratory tract infections. Higher dosing was noted in the Americas compared to the European region.
Antibiotic dosing in children clusters around a small number of doses, although variation remains. There is a clear opportunity for the clinical, scientific and public health communities to consolidate behind a consistent set of global antibiotic dosing guidelines to harmonise current practice and prioritise future research.
摘要：
儿科全球抗生素指南不一致，很可能是由于该人群的药代动力学和疗效数据有限。我们使用来自五个全球点患病率调查的数据调查了抗生素剂量变化的潜在因素。
分析了23个国家/地区对1个月至12岁儿童使用的16种最常见的静脉抗生素的3,367剂数据。对于每一种抗生素，我们确定了基于体重的剂量（mg/kg/天）或固定日剂量（mg/天）的标准剂量，并调查了使用每种策略的给药模式。使用线性混合效应模型研究了基于体重的剂量变化的潜在因素。基于体重的给药（以毫克/千克/天为单位）聚集在少数峰周围，并且所有抗生素都有1-3个基于体重的标准剂量，在5%-48%的剂量中使用。除替考拉宁外，所有抗生素的给药策略通常是基于体重的，而不是固定的每日给药。每种策略的给药比例大致相等。没有强烈一致的模式出现，以解释历史变化的实际体重为基础的剂量使用除了较高的剂量在中枢神经系统感染，与下呼吸道感染相比，皮肤和软组织感染较低。与欧洲地区相比，美洲的剂量更高。
儿童抗生素剂量集中在少量剂量，虽然变化仍然存在。临床上有明显的机会，科学和公共卫生社区巩固一套一致的全球抗生素给药指南，以协调当前的实践并优先考虑未来的研究。
分析了23个国家/地区对1个月至12岁儿童使用的16种最常见的静脉抗生素的3,367剂数据。
儿童抗生素剂量集中在少量剂量，
