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Original article
Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based: a French national survey
  1. Stéphanie Leroux1,2,3,
  2. Wei Zhao1,2,4,5,
  3. Pierre Bétrémieux3,
  4. Patrick Pladys3,6,
  5. Elie Saliba7,
  6. Evelyne Jacqz-Aigrain1,2,4,
  7. on behalf of the French Society of Neonatology
  1. 1Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, APHP, Paris, France
  2. 2EA7323, Université Paris Diderot-Université Paris Descartes, Paris, France
  3. 3Division of Neonatology, Department of Child and Adolescent Medicine, CHU de Rennes, Rennes, France
  4. 4Clinical Investigation Center CIC1426, INSERM, Paris, France
  5. 5Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Jinan, China
  6. 6INSERM U1099, Institut des Neurosciences Cliniques de Rennes, Rennes, France
  7. 7Paediatric and Neonatal Intensive Care Unit, CHRU Tours, Tours, France
  1. Correspondence to Dr Evelyne Jacqz-Aigrain, Department of Pediatric Pharmacology and Pharmacogenetics, Clinical Investigation Center CIC1426, INSERM, Hôpital Robert Debré, 48 Boulevard Sérurier, 75935 Paris Cedex 19, France; evelyne.jacqz-aigrain{at}rdb.aphp.fr

Abstract

Objective This survey aims to describe and analyse the dosage regimens of antibiotics in French neonatal intensive care units (NICUs).

Methods Senior doctors from 56 French NICUs were contacted by telephone and/or email to provide their local guidelines for antibiotic therapy.

Results 44 (79%) NICUs agreed to participate in this survey. In total, 444 dosage regimens were identified in French NICUs for 41 antibiotics. The number of different dosage regimens varied from 1 to 32 per drug (mean 9, SD 7.8). 37% of intravenous dosage regimens used a unique mg/kg dose from preterm to full-term neonates. Doses and/or dosing intervals varied significantly for 12 antibiotics (amikacin, gentamicin, netilmicin, tobramycin, vancomycin administered as continuous infusion, ceftazidime, cloxacillin, oxacillin, penicillin G, imipenem/cilastatin, clindamycin and metronidazole). Among these antibiotics, 6 were used in more than 70% of local guidelines and had significant variations in (1) maintenance daily doses for amikacin, imipenem/cilastatin, ceftazidime and metronidazole; (2) loading doses for continuous infusion of vancomycin; and (3) dosing intervals for gentamicin and amikacin.

Conclusions A considerable inter-centre variability of dosage regimens of antibiotics exists in French NICUs. Developmental pharmacokinetic–pharmacodynamic studies are essential for the evaluation of antibiotics in order to establish evidence-based dosage regimens for effective and safe administration in neonates.

  • Infectious Diseases
  • Neonatology
  • Pharmacology
  • Evidence Based Medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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