title: Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based: a French national survey.
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.
authors: Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, APHP, Paris, France EA7323, Université Paris Diderot-Université Paris Descartes, Paris, France Division of Neonatology, Department of Child and Adolescent Medicine, CHU de Rennes, Rennes, France.
authors: Stéphanie
authors: S
authors: Leroux
authors: Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, APHP, Paris, France EA7323, Université Paris Diderot-Université Paris Descartes, Paris, France Clinical Investigation Center CIC1426, INSERM, Paris, France Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Jinan, China.
authors: Wei
authors: W
authors: Zhao
authors: Division of Neonatology, Department of Child and Adolescent Medicine, CHU de Rennes, Rennes, France.
authors: Pierre
authors: P
authors: Bétrémieux
authors: Division of Neonatology, Department of Child and Adolescent Medicine, CHU de Rennes, Rennes, France INSERM U1099, Institut des Neurosciences Cliniques de Rennes, Rennes, France.
authors: Patrick
authors: P
authors: Pladys
authors: Paediatric and Neonatal Intensive Care Unit, CHRU Tours, Tours, France.
authors: Elie
authors: E
authors: Saliba
authors: Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, APHP, Paris, France EA7323, Université Paris Diderot-Université Paris Descartes, Paris, France Clinical Investigation Center CIC1426, INSERM, Paris, France.
authors: Evelyne
authors: E
authors: Jacqz-Aigrain
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D005602:France; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'
chemical_list: D000900:Anti-Bacterial Agents
keywords: Evidence Based Medicine; Infectious Diseases; Neonatology; Pharmacology