Pharmacokinetics of Commonly Used Antimicrobials in Critically Ill Pediatric Patients During Extracorporeal Membrane Oxygenation: A Systematic Review.
| Title: | Pharmacokinetics of Commonly Used Antimicrobials in Critically Ill Pediatric Patients During Extracorporeal Membrane Oxygenation: A Systematic Review. |
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| Authors: | Duceppe MA; Department of Pharmacy, McGill University Health Centre, 1001 Décarie, Local C-RC 6004, Montreal, QC, Canada, H4A 3J1. duceppe.marc.alexandre@gmail.com.; Kanji S; Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.; Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada.; Do AT; Department of Pharmacy, McGill University Health Centre, 1001 Décarie, Local C-RC 6004, Montreal, QC, Canada, H4A 3J1.; Ruo N; Department of Pharmacy, McGill University Health Centre, 1001 Décarie, Local C-RC 6004, Montreal, QC, Canada, H4A 3J1.; Cavayas YA; Department of Medicine, Division of Critical Care, Hôpital du Sacré-Coeur de Montréal Research Centre, Montreal, QC, Canada.; Department of Surgery, Division of Critical Care, Montreal Heart Institute, Montreal, QC, Canada.; Département de Médecine, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada.; Albert M; Department of Medicine, Division of Critical Care, Hôpital du Sacré-Coeur de Montréal Research Centre, Montreal, QC, Canada.; Department of Surgery, Division of Critical Care, Montreal Heart Institute, Montreal, QC, Canada.; Département de Médecine, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada.; Robert-Halabi M; Department of Medicine, Division of Cardiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.; Zavalkoff S; Department of Pediatrics, Division of Pediatric Critical Care, McGill University Health Centre, Montreal, QC, Canada.; Faculty of Medicine, McGill University, Montreal, QC, Canada.; Benichou L; Faculté de Pharmacie, Université Paris Descartes, Paris, France.; Samoukovic G; Faculty of Medicine, McGill University, Montreal, QC, Canada.; Department of Surgery, Division of Critical Care, McGill University Health Centre, Montreal, QC, Canada.; Williamson DR; Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada.; Department of Pharmacy, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada. |
| Source: | Paediatric drugs [Paediatr Drugs] 2023 Sep; Vol. 25 (5), pp. 515-535. Date of Electronic Publication: 2023 Jul 14. |
| Publication Type: | Systematic Review; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Springer International Country of Publication: Switzerland NLM ID: 100883685 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1179-2019 (Electronic) Linking ISSN: 11745878 NLM ISO Abbreviation: Paediatr Drugs Subsets: MEDLINE |
| Imprint Name(s): | Publication: June 2010- : Cham, Switzerland : Springer International; Original Publication: Auckland ; Philadelphia : Adis International, c1999- |
| MeSH Terms: | Extracorporeal Membrane Oxygenation*/adverse effects ; Anti-Infective Agents*/therapeutic use ; Drug-Related Side Effects and Adverse Reactions*; Critical Illness/therapy ; Infant, Newborn ; Humans ; Child ; Drug Monitoring |
| Abstract: | Purpose: Adequate dosing of antimicrobials is critical to properly treat infections and limit development of resistance and adverse effects. Limited guidance exist for antimicrobial dosing adjustments in patients requiring extracorporeal membrane oxygenation (ECMO) therapy, particularly in the pediatric population. A systematic review was conducted to delineate the pharmacokinetics (PK) and pharmacodynamics (PD) of antimicrobials in critically ill neonates and children requiring ECMO therapy.; Methods: Medline, EMBASE, Global Health and All EBM Reviews databases were queried. Grey literature was examined. All clinical studies reporting PK/PD parameters of antimicrobials in critically ill pediatric patients treated with ECMO were included, except for case reports and congress abstracts. Two independent reviewers applied the inclusion and exclusion criteria. Reviewers were then paired to independently extract data and evaluate the methodological quality of studies using the ROBINS-I tool and the compliance with ClinPK reporting guidelines. Patient and study characteristics, key PK/PD findings, details of ECMO circuits and co-treatments were summarized qualitatively. Broad dosing recommendations were formulated based on the available data for specific antimicrobials.; Results: Twenty-nine clinical studies were included; most were observational and uncontrolled. Patient characteristics and co-treatments were often missing. The effect of ECMO on PK/PD parameters of antimicrobials varied depending on the drugs and population studied. It was only possible to formulate dosing recommendations for a few antimicrobials given the paucity of data, its overall low quality and heterogeneity in reporting.; Conclusion: Limited data exists on the PK/PD of antimicrobials during ECMO therapy in the pediatric population. Rigorously designed population PK studies are required to establish empiric dosing guidelines for antimicrobials in patients requiring this therapeutic modality. The use of therapeutic drug monitoring for antimicrobials in pediatric patients on ECMO should be encouraged to optimize dosing.; Trial Registry: PROSPERO registration number: CRD42018099992 (Registered: July 24th 2018).; (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.) |
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| Substance Nomenclature: | 0 (Anti-Infective Agents) |
| Entry Date(s): | Date Created: 20230714 Date Completed: 20230811 Latest Revision: 20230811 |
| Update Code: | 20260130 |
| DOI: | 10.1007/s40272-023-00582-x |
| PMID: | 37450191 |
| Database: | MEDLINE |
Systematic Review; Journal Article