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Aminoglycoside use in a pediatric hospital: there is room for improvement—a before/after study

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Abstract

Aminoglycoside prescriptions were rarely evaluated in children care facilities. Because of risk of toxicity, these narrow spectrum antibiotics are commonly misused. In this study, we evaluate aminoglycoside prescription and assess the impact of an information campaign on modalities of prescription and monitoring practices in a pediatric hospital. This prospective study, before/after diffusion of local recommendations, has been conducted over 6 months. All computerized prescriptions were analyzed. A semi-passive diffusion of local recommendations to prescribers allowed researchers to differentiate between a pre-intervention (P1) and post-intervention period (P2). Endpoints were the improvement of administered doses (mg/kg), modalities of administration, treatment duration, indications, and the presence of pharmacological monitoring. Three hundred and ten prescriptions were analyzed (P1 = 163, P2 = 147). Most common sites of infection treated were as follows: joint–bone (33 %), urinary tract (17 %) and intra-abdominal (15 %). Among all prescriptions, respectively, 12 and 13 % were avoidable. Short-duration treatment and single daily dosing seem to be widely achieved, but despite an improvement between the two periods, 45 % of prescribed doses in P2 were still below our recommendations (77 % in P1).

Conclusion: The semi-passive diffusion of recommendations has not improved significantly medical practices. Active diffusion with a regular monitoring could be useful to improve the use of aminoglycosides.

What is Known:

Misuse of aminoglycosides has been frequently described and evaluated in adult hospitals.

This misuse could be explained by their nephrotoxicity and their low therapeutic index.

What is New:

Through this study, conducted in a pediatric hospital, we highlighted that practitioners misunderstand the aminoglycoside pharmacokinetic and pharmacodynamic targets and 12.3 % of aminoglycoside prescriptions could be avoided.

Finally, we showed that a semi-passive diffusion of local recommendations is not enough to improve aminoglycoside prescriptions.

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Abbreviations

MIC:

Minimum inhibitory concentration

NEM:

Necker-Enfants Malades hospital

Pk/Pd:

Pharmacokinetic/pharmacodynamic

P1:

Pre-interventional period

P2:

Post-interventional period

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Authors’ contributions

BP, CP, CS, JRZ, and MH were responsible for data collection. JRZ, MH,MP, and VT were responsible for analysis and interpretation of data. MH was responsible for writing manuscript. JR Zahar was responsible for supervising work and approved the final manuscript as submitted.

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Correspondence to Jean-Ralph Zahar.

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This article does not contain any studies with human participants performed by any of the authors.

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This project was done with no specific support or funds.

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The authors declare that they have no competing interests, and no financial relationship with the organization that sponsored the research.

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Communicated by David Nadal

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Houot, M., Pilmis, B., Thepot-Seegers, V. et al. Aminoglycoside use in a pediatric hospital: there is room for improvement—a before/after study. Eur J Pediatr 175, 659–665 (2016). https://doi.org/10.1007/s00431-016-2691-0

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  • DOI: https://doi.org/10.1007/s00431-016-2691-0

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