Amikacin is widely used in the treatment of suspected or confirmed neonatal infections. However, dosage regimens are not well defined in this group of patients because of a wide inter-individual ...pharmacokinetic variability. An individualized goal-oriented amikacin dosage design was applied using population pharmacokinetic data. A dosing chart was developed for neonates during the first 2 days of life, by using population pharmacokinetic parameter values and USCPACK software. This dosing chart based on gestational age (GA) and body weight gives a once-a-day amikacin dosage regimen involving an injection every 24 h. Validation was performed in 57 neonates less than 2 days old, divided into three GA groups and prospectively treated using the dosing chart. Target peak serum levels of amikacin were obtained in 62-80% of patients after the first dose and in 80-100% after the second dose, and trough concentrations were obtained in 100%. This study has confirmed the need for individualization of amikacin dosage regimens in neonates.
This study had for aim to identify factors limiting the implementation of clinical guidelines related to the use of expensive antifungal drugs in pediatric hemato-oncology.
A retrospective study was ...conducted in a Lyon teaching hospital (France), from February to December 2008. The compliance of antifungal prescription to French guidelines was assessed. Audit findings were interpreted using both semi-directed interviews of six prescribers (qualitative approach) and statistical analysis of prescriptions (quantitative approach).
Fifty antifungal prescriptions were studied. The compliance with clinical guidelines reached 66% (CI 95% 52-80%). The semi-directed interviews revealed that five issues may have influenced the adherence of prescribers with recommended practices: the guidelines, the molecule, the prescriber, the child, and practice settings. The statistical analysis did not reveal any link between the prescriber's activities or his department and the compliance with guidelines. A significant association was found between the documentation of infection and the non-conformity of antifungal prescriptions (p=0.02).
This study, combining qualitative and quantitative assessments, addressed potential issues related to the implementation of guidelines in specific patient groups or to their adaptation in the context of pediatric hematology-oncology. Harmonization of practices related to the widespread use of antifungal associations is required.
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