Journal
JOURNAL OF CLINICAL PHARMACOLOGY
Volume 58, Issue 10, Pages S108-S122Publisher
WILEY
DOI: 10.1002/jcph.1128
Keywords
Pharmacokinetic; pharmacodynamic; pediatrics; neonates; antimicrobials; vancomycin; Monte Carlo simulation; beta-lactams; vancomycin; aminoglycosides; antibiotics; Bayesian methods; opportunistic study; ceftaroline
Categories
Funding
- NICHD
- NIAID [1U54HD090259, 1K23AI089978]
- Duke University [HHSN27500027]
- NICHD [1U54HD090259]
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT [U54HD090259] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [K23AI089978, R21AI090259] Funding Source: NIH RePORTER
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The selection of the right antibiotic and right dose necessitates clinicians understand the contribution of pharmacokinetic variability stemming from age-related physiologic maturation and the pharmacodynamics to optimize drug exposure for clinical response. The complexity of selecting the right dose arises from the multiplicity of pediatric age groups, from premature neonates to adolescents. Body size and age (which relate to organ function) must be incorporated to optimize antibiotic dosing in this vulnerable population. In the effort to optimize and individualize drug dosing regimens, clinical pharmacometrics that incorporate population-based pharmacokinetic modeling, Bayesian estimation, and Monte Carlo simulations are utilized as a quantitative approach to understanding and predicting the pharmacology and clinical and microbiologic efficacy of antibiotics. In addition, opportunistic study designs and alternative blood sampling strategies can serve as practical approaches to ensure successful conduct of pediatric studies. This review article examines relevant literature on optimization of antibiotic pharmacotherapy in pediatric populations published within the last decade. Specific pediatric antibiotic data, including beta-lactam antibiotics, aminoglycosides, and vancomycin, are critically evaluated.
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