title: A worrying trend in weight-adjusted paediatric antibiotic use in a Norwegian tertiary care hospital.
abstract: OBJECTIVE
  The World Health Organization recommends the defined daily dose (DDD) as the standard unit of measurement for antibiotic use, but this is not applicable in children. We aimed to assess paediatric antibiotic use in a Norwegian tertiary care hospital using a novel weight-adjusted method.
  
  
  METHODS
  We obtained antibiotic purchase data from the hospital pharmacy and administrative data for all admissions from 2002 to 2009 to the paediatric wards at Oslo University Hospital, Rikshospitalet. Recommended daily doses per 100 kg days (RDDs/kg days) were calculated based on national guidelines for paediatric antibiotic use, length of stay and estimated weight for sex and age using national growth references.
  
  
  RESULTS
  Total antibiotic use increased significantly from 51.8 to 65.5 RDDs/100 kg days. We found statistically significant annual increases in the consumption of carbapenems (18.0%), third-generation cephalosporins (6.0%) and imidazole derivatives (6.6%) and a considerable difference between total antibiotic use measured in RDDs/100 kg days and DDDs/100 bed days for neonates.
  
  
  CONCLUSIONS
  Weight-adjusted antibiotic use provided a more meaningful description of the quantities of antibiotics consumed than DDDs/100 bed days, particularly for neonates. Total antibiotic use, use of meropenem, third-generation cephalosporins and imidazole derivatives increased significantly despite low prevalence of antibiotic-resistant pathogens.
authors.affiliation: Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Raastad
authors.affiliation: The Norwegian Computing Center, Oslo, Norway.
authors.forename: Ingunn Fride
authors.initials: IF
authors.lastname: Tvete
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Department of Pediatrics, Oslo University Hospital, Oslo, Norway.
authors.forename: Tore G
authors.initials: TG
authors.lastname: Abrahamsen
authors.affiliation: Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Dag
authors.initials: D
authors.lastname: Berild
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Truls M
authors.initials: TM
authors.lastname: Leegaard
authors.affiliation: Microbiology Section, Laboratory Centre, Vestre Viken Hospital Trust, Rud, Norway.
authors.forename: Mette
authors.initials: M
authors.lastname: Walberg
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Department of Microbiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Müller
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009664:Norway; D010818:Practice Patterns, Physicians'; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibacterial agents; Defined daily dose; Drug utilisation; Hospitalised children; Recommended daily dose