Optimizing the Use of Antibiotic Agents in the Pediatric Intensive Care Unit: A Narrative Review
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REVIEW ARTICLE
Optimizing the Use of Antibiotic Agents in the Pediatric Intensive Care Unit: A Narrative Review Jef Willems1 · Eline Hermans2,3 · Petra Schelstraete4 · Pieter Depuydt5 · Pieter De Cock1,3,6 Accepted: 24 October 2020 © Springer Nature Switzerland AG 2020
Abstract Antibiotics are one of the most prescribed drug classes in the pediatric intensive care unit, yet the incidence of inappropriate antibiotic prescribing remains high in critically ill children. Optimizing the use of antibiotics in this population is imperative to guarantee adequate treatment, avoid toxicity and the occurrence of antibiotic resistance, both on a patient level and on a population level. Antibiotic stewardship encompasses all initiatives to promote responsible antibiotic usage and the PICU represents a major target environment for antibiotic stewardship programs. This narrative review provides a summary of the available knowledge on the optimal selection, duration, dosage, and route of administration of antibiotic treatment in critically ill children. Overall, more scientific evidence on how to optimize antibiotic treatment is warranted in this population. We also give our personal expert opinion on research priorities.
Key Points Optimizing antimicrobial treatment should focus on the optimal selection, dosage, and duration of antimicrobial treatment, via the optimal route of administration. In critically ill children, little research has been conducted to increase the appropriate use of antibiotics.
* Pieter De Cock [email protected] 1
Department of Pediatric Intensive Care, Ghent University Hospital, Gent, Belgium
2
Department of Pediatrics, Ghent University Hospital, Gent, Belgium
3
Heymans Institute of Pharmacology, Ghent University, Gent, Belgium
4
Department of Pediatric Pulmonology, Ghent University Hospital, Gent, Belgium
5
Department of Intensive Care Medicine, Ghent University Hospital, Gent, Belgium
6
Department of Pharmacy, Ghent University Hospital, Gent, Belgium
1 Introduction The development of antibiotics has revolutionized modern medicine, not only by offering a cure for common potentially life-threatening communicable diseases such as communityacquired pneumonia, but also by facilitating surgical and oncologic therapies in which nosocomial infections are a major cause of morbidity and mortality [1]. Although potentially life-saving, antibiotic usage is not without problems. Adverse reactions, albeit most often mild, are a common reason for medical consultation, but more severe adverse reactions such as Stevens-Johnson syndrome may occur as well. Use of broad-spectrum antibiotics in an in-hospital setting is also strongly linked to Clostridioides difficile infections, a common reason for increased length of hospital stay (LOS), often in vulnerable patients [2]. The impact of broad-spectrum antibiotic use on the gut microbiome, with possible links to development of auto-immune diseases, is a hot topic in research [3]. These adverse effects are rarely discussed with patient
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