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Ngougni Pokem P, Vanneste D, Schouwenburg S, Abdulla A, Gijsen M, Dhont E, Van der Linden D, Spriet I, De Cock P, Koch B, Van Bambeke F, Wijnant GJ. Dose optimization of β-lactam antibiotics in children: from population pharmacokinetics to individualized therapy. Expert Opin Drug Metab Toxicol 2024:1-18. [PMID: 39078238 DOI: 10.1080/17425255.2024.2385403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/21/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION β-Lactams are the most widely used antibiotics in children. Their optimal dosing is essential to maximize their efficacy, while minimizing the risk for toxicity and the further emergence of antimicrobial resistance. However, most β-lactams were developed and licensed long before regulatory changes mandated pharmacokinetic studies in children. As a result, pediatric dosing practices are poorly harmonized and off-label use remains common today. AREAS COVERED β-Lactam pharmacokinetics and dose optimization strategies in pediatrics, including fixed dose regimens, therapeutic drug monitoring, and model-informed precision dosing are reviewed. EXPERT OPINION/COMMENTARY Standard pediatric doses can result in subtherapeutic exposure and non-target attainment for specific patient subpopulations (neonates, critically ill children, e.g.). Such patients could benefit greatly from more individualized approaches to dose optimization, beyond a relatively simple dose adaptation based on weight, age, or renal function. In this context, Therapeutic Drug Monitoring (TDM) and Model-Informed Precision Dosing (MIPD) emerge as particularly promising avenues. Obstacles to their implementation include the lack of strong evidence of clinical benefit due to the paucity of randomized clinical trials, of standardized assays for monitoring concentrations, or of adequate markers for renal function. The development of precision medicine tools is urgently needed to individualize therapy in vulnerable pediatric subpopulations.
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Affiliation(s)
- Perrin Ngougni Pokem
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Department of Microbiology, Cliniques Universitaires Saint-Luc - Université catholique de Louvain, Brussels, Belgium
| | - Dorian Vanneste
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Stef Schouwenburg
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Alan Abdulla
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Matthias Gijsen
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Pharmacy Department, UZ Leuven, Leuven, Belgium
| | - Evelyn Dhont
- Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Dimitri Van der Linden
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
- Pediatric Infectious Diseases, Service of Specialized Pediatrics, Department of Pediatrics, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Isabel Spriet
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Pharmacy Department, UZ Leuven, Leuven, Belgium
| | - Pieter De Cock
- Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - Birgit Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Gert-Jan Wijnant
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Reza N, Gerada A, Stott KE, Howard A, Sharland M, Hope W. Challenges for global antibiotic regimen planning and establishing antimicrobial resistance targets: implications for the WHO Essential Medicines List and AWaRe antibiotic book dosing. Clin Microbiol Rev 2024; 37:e0013923. [PMID: 38436564 PMCID: PMC11324030 DOI: 10.1128/cmr.00139-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
SUMMARYThe World Health Organisation's 2022 AWaRe Book provides guidance for the use of 39 antibiotics to treat 35 infections in primary healthcare and hospital facilities. We review the evidence underpinning suggested dosing regimens. Few (n = 18) population pharmacokinetic studies exist for key oral AWaRe antibiotics, largely conducted in homogenous and unrepresentative populations hindering robust estimates of drug exposures. Databases of minimum inhibitory concentration distributions are limited, especially for community pathogen-antibiotic combinations. Minimum inhibitory concentration data sources are not routinely reported and lack regional diversity and community representation. Of studies defining a pharmacodynamic target for ß-lactams (n = 80), 42 (52.5%) differed from traditionally accepted 30%-50% time above minimum inhibitory concentration targets. Heterogeneity in model systems and pharmacodynamic endpoints is common, and models generally use intravenous ß-lactams. One-size-fits-all pharmacodynamic targets are used for regimen planning despite complexity in drug-pathogen-disease combinations. We present solutions to enable the development of global evidence-based antibiotic dosing guidance that provides adequate treatment in the context of the increasing prevalence of antimicrobial resistance and, moreover, minimizes the emergence of resistance.
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Affiliation(s)
- Nada Reza
- Department of
Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems,
Molecular and Integrative Biology, University of
Liverpool, Liverpool,
United Kingdom
- Liverpool University
Hospitals NHS Foundation Trust,
Liverpool, United Kingdom
| | - Alessandro Gerada
- Department of
Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems,
Molecular and Integrative Biology, University of
Liverpool, Liverpool,
United Kingdom
- Liverpool University
Hospitals NHS Foundation Trust,
Liverpool, United Kingdom
| | - Katharine E. Stott
- Department of
Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems,
Molecular and Integrative Biology, University of
Liverpool, Liverpool,
United Kingdom
- Liverpool University
Hospitals NHS Foundation Trust,
Liverpool, United Kingdom
| | - Alex Howard
- Department of
Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems,
Molecular and Integrative Biology, University of
Liverpool, Liverpool,
United Kingdom
- Liverpool University
Hospitals NHS Foundation Trust,
Liverpool, United Kingdom
| | - Mike Sharland
- Centre for Neonatal
and Paediatric Infection, Institute for Infection and Immunity, St
George’s, University of London,
London, United Kingdom
| | - William Hope
- Department of
Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems,
Molecular and Integrative Biology, University of
Liverpool, Liverpool,
United Kingdom
- Liverpool University
Hospitals NHS Foundation Trust,
Liverpool, United Kingdom
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Aguilera-Alonso D, Cantón R, Giske CG, Kahlmeter G, Kohns Vasconcelos M, Papan C, Turnidge J. Searching High and Low: Call for a Joint European Society for Paediatric Infectious Diseases-European Committee on Antimicrobial Susceptibility Testing Survey on Dosage of Antibacterial Agents in Children-Part One. Pediatr Infect Dis J 2022; 41:e182-e185. [PMID: 35153290 DOI: 10.1097/inf.0000000000003457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- David Aguilera-Alonso
- Pediatric Infectious Diseases Unit, Gregorio Marañón Hospital, Instituto de Investigación Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso, Madrid, Spain, CIBER en Enfermedades Infecciosas, Madrid, Spain
| | - Rafael Cantón
- CIBER en Enfermedades Infecciosas, Madrid, Spain, Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain, EUCAST Clinical Data Coordinator
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden, Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Kahlmeter
- EUCAST Technical Data Coordinator, EUCAST Development Laboratory, Växjö, Sweden
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology and Department for Paediatric Pharmacolgy, University of Basel Children's Hospital, Basel, Switzerland, Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Cihan Papan
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - John Turnidge
- EUCAST Scientific Secretary, University of Adelaide, ESPID-EUCAST Joint Task Force
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Alonso DA, Cantón R, Giske CG, Kahlmeter G, Vasconcelos MK, Papan C, Turnidge J. Searching high and low: Call for a joint ESPID-EUCAST survey on dosage of antibacterial agents in children - Part One. Clin Microbiol Infect 2022; 28:625-627. [PMID: 34999172 DOI: 10.1016/j.cmi.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/03/2022]
Affiliation(s)
- David Aguilera Alonso
- Pediatric Infectious Diseases Unit, Gregorio Marañón Hospital, Instituto de Investigación Gregorio Marañón (IiSGM), Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Madrid, Spain; CIBER en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
| | - Rafael Cantón
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain; Servicio de Microbiología. Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; EUCAST Clinical Data Coordinator
| | - Christian G Giske
- Division of Clinical microbiology, Department of Laboratory medicine, Karolinska Institutet, Stockholm, Sweden; Clinical microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Kahlmeter
- EUCAST Technical Data Coordinator, EUCAST Development Laboratory, Växjö, Sweden
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology and Department for Paediatric Pharmacolgy, University of Basel Children's Hospital (UKBB), Basel, Switzerland; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Cihan Papan
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
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