Beta-Lactams Therapeutic Monitoring in Septic Children–What Target Are We Aiming for? A Scoping Review

Frontiers in Pediatrics

article

Ronaldo Morales Junior¹  Gabriela Otofuji Pereira¹  Gustavo Magno Baldin Tiguman³  Vanessa D'Amaro Juodinis²  João Paulo Telles⁴  Daniela Carla de Souza²  Silvia Regina Cavani Jorge Santos¹ 

[1] Clinical Pharmacokinetics Center, School of Pharmaceutical Sciences, University of São Paulo;Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Sírio-Libanês;Faculty of Pharmaceutical Sciences, State University of Campinas;Department of Infectious Diseases, AC Camargo Cancer Center;Pediatric Intensive Care Unit, University Hospital, University of São Paulo

关键词: therapeutic drug monitoring;    beta-lactams;    pharmacokinetics;    pharmacodynamics;    pediatrics;    sepsis;   

DOI  :  10.3389/fped.2022.777854

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

The antimicrobial therapy of sepsis and septic shock should be individualized based on pharmacokinetic/pharmacodynamic (PK/PD) parameters to deliver effective and timely treatment of life-threatening infections. We conducted a literature scoping review to identify therapeutic targets of beta-lactam antibiotics in septic pediatric patients and the strategies that have been applied to overcome sepsis-related altered pharmacokinetics and increase target attainment against susceptible pathogens. A systematic search was conducted in the MEDLINE, EMBASE and Web of Science databases to select studies conducted since 2010 with therapeutic monitoring data of beta-lactams in septic children. Last searches were performed on 02 September 2021. Two independent authors selected the studies and extracted the data. A narrative and qualitative approach was used to summarize the findings. Out of the 118 identified articles, 21 met the eligibility criteria. Population pharmacokinetic modeling was performed in 12 studies, while nine studies reported data from bedside monitoring of beta-lactams. Most studies were conducted in the United States of America ( n = 9) and France ( n = 5) and reported PK/PD data of amoxicillin, ampicillin, azlocillin, aztreonam, cefazolin, cefepime, cefotaxime, ceftaroline, ceftazidime, doripenem, meropenem and piperacillin/tazobactam. Therapeutic targets ranged from to 40% f T> MIC to 100% f T> 6 × MIC. Prolonging the infusion time and frequency were most described strategies to increase target attainment. Monitoring beta-lactam serum concentrations in clinical practice may potentially maximize therapeutic target attainment. Further studies are required to define the therapeutic target associated with the best clinical outcomes.

【 授权许可】

CC BY