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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Antimicrobial defined daily dose adjusted by weight: a proposal for antibiotic c...
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Vol. 37. Issue 5.
Pages 287-358 (May 2019)
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Vol. 37. Issue 5.
Pages 287-358 (May 2019)
Original article
DOI: 10.1016/j.eimce.2018.07.018
Antimicrobial defined daily dose adjusted by weight: a proposal for antibiotic consumption measurement in children
Dosis diaria definida ajustada por peso: una propuesta para la medición de consumo antimicrobiano en pediatría
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Elena Montecatine-Alonsoa,1, María-Victoria Gil-Navarroa,1, Cecilia M. Fernández-Llamazaresb, Aurora Fernández-Poloc, Pere Soler-Palacínd, Jesús Llorente-Gutiérreze, María-Teresa Gómez-Travecedo Calvof, María-Dolores Esquivel-Morag, Icíar Pérez-Rodrigoh, José M. Cisnerosi, Walter-Alfredo Goycochea-Valdiviaj,
Corresponding author
alfgova@gmail.com

Corresponding author.
, Olaf Nethj, for the Paediatric Antimicrobial Defined Daily Dose Study Group (KiDDDs)
a Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Department of Pharmacy, Hospital Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón. Research Network on Maternal and Child Health and Development II (Red SAMID II). Spanish Health Institute Carlos III, Madrid, Spain
c Department of Pharmacy, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, PROA-NEN project, Barcelona, Spain
d Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, PROA-NEN project, Barcelona, Spain
e Department of Pharmacy, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
f Department of Pharmacy, Hospital Universitario de Jerez, Jeréz de la Frontera, Cádiz, Spain
g Department of Paediatrics, Hospital Universitario de Jerez, Jeréz de la Frontera, Cádiz, Spain
h Department of Pharmacy, Hospital Universitario Reina Sofía, Córdoba, Spain
i Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
j Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Sevilla, Institute of Biomedicine of Seville (IBIS), Spain
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Tables (2)
Table 1. Paediatric defined daily dose of intravenously administered antimicrobials according to the results of Delphi method.
Table 2. Paediatric defined daily dose of orally administered antimicrobials according to the results of Delphi method.
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Abstract
Introduction

Antimicrobial defined daily dose (DDD), has limitations for antimicrobial consumption measurement in paediatrics. An alternative DDD design applicable for children is proposed.

Methods

Children (<16 years-old) from 10 Spanish hospitals during a 12-months period were included. Weight for age (50th percentile) was calculated for the median age of the cohort using standardized World Health Organization tables. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication.

Results

A total of 40,575 children were included. Median age was 4.17 (IQR: 1.36–8.98) and 4.81 (IQR: 1.42–9.60) years for boys and girls, respectively. Mean weight for this age was 17.08kg. Standardized DDD for representative antimicrobials were calculated.

Conclusions

A useful method for antimicrobial DDD measurement in paediatrics has been proposed and should be validated in future studies for its use in paediatric antimicrobial stewardship programmes.

Keywords:
Antibiotic prescription
Antibiotic usage
Antimicrobial management
Paediatrics
Resumen
Introducción

La dosis diaria definida (DDD), tiene limitaciones para la medición del consumo antimicrobiano en pediatría. Se propone un diseño aplicable en niños.

Métodos

Se incluyeron niños (<16 años) de 10 hospitales españoles durante un periodo de 12 meses. A partir de la mediana de edad de la cohorte, utilizando tablas estandarizadas de la OMS, se obtuvo el peso correspondiente al percentil P50 de esa edad. Se calculó la DDD (gr) multiplicando el peso obtenido por la dosis recomendada (mg/kg) de cada antimicrobiano para su indicación más común.

Resultados

Un total de 40575 niños fueron incluidos. La mediana de edad fue 4,17 (RIQ: 1,36–8,98) y 4,81 (RIQ: 1,42–9,60) años para niños y niñas, respectivamente. Peso medio para la edad: 17,08kg. DDD estandarizadas fueron calculadas para antimicrobianos representativos.

Conclusiones

Se ha propuesto un método útil para monitorizar consumo antimicrobiano en pediatría utilizando DDD adaptadas, que deberá validarse en futuros estudios.

Palabras clave:
Prescripción antibiótica
Uso de antibióticos
Manejo de antibióticos
Pediatría

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