title: Aminoglycoside use in a pediatric hospital: there is room for improvement-a before/after study.
abstract: Aminoglycoside prescriptions were rarely evaluated in children care facilities. Because of risk of toxicity, these narrow spectrum antibiotics are commonly misused. In this study, we evaluate aminoglycoside prescription and assess the impact of an information campaign on modalities of prescription and monitoring practices in a pediatric hospital. This prospective study, before/after diffusion of local recommendations, has been conducted over 6 months. All computerized prescriptions were analyzed. A semi-passive diffusion of local recommendations to prescribers allowed researchers to differentiate between a pre-intervention (P1) and post-intervention period (P2). Endpoints were the improvement of administered doses (mg/kg), modalities of administration, treatment duration, indications, and the presence of pharmacological monitoring. Three hundred and ten prescriptions were analyzed (P1 = 163, P2 = 147). Most common sites of infection treated were as follows: joint-bone (33 %), urinary tract (17 %) and intra-abdominal (15 %). Among all prescriptions, respectively, 12 and 13 % were avoidable. Short-duration treatment and single daily dosing seem to be widely achieved, but despite an improvement between the two periods, 45 % of prescribed doses in P2 were still below our recommendations (77 % in P1).
  
  
  CONCLUSIONS
  The semi-passive diffusion of recommendations has not improved significantly medical practices. Active diffusion with a regular monitoring could be useful to improve the use of aminoglycosides.
  
  
  BACKGROUND
  • Misuse of aminoglycosides has been frequently described and evaluated in adult hospitals. • This misuse could be explained by their nephrotoxicity and their low therapeutic index. What is New: • Through this study, conducted in a pediatric hospital, we highlighted that practitioners misunderstand the aminoglycoside pharmacokinetic and pharmacodynamic targets and 12.3 % of aminoglycoside prescriptions could be avoided. • Finally, we showed that a semi-passive diffusion of local recommendations is not enough to improve aminoglycoside prescriptions.
authors.affiliation: Pharmacy Department, CHU Necker-Enfants Malades, 149 rue de Sèvres, Paris, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Houot
authors.affiliation: Infection Control Unit, CHU Necker-Enfants Malades, 149 rue de Sèvres, Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Pilmis
authors.affiliation: Cellular Interactions and Therapeutic Applications Department, CHU Angers, 49933, Angers Cedex 9, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Thepot-Seegers
authors.affiliation: Pharmacy Department, CHU Necker-Enfants Malades, 149 rue de Sèvres, Paris, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Suard
authors.affiliation: Pharmacy Department, CHU Necker-Enfants Malades, 149 rue de Sèvres, Paris, France.
authors.forename: Cyrielle
authors.initials: C
authors.lastname: Potier
authors.affiliation: Pharmacy Department, CHU Necker-Enfants Malades, 149 rue de Sèvres, Paris, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Postaire
authors.affiliation: Infection Control Unit, CHU Necker-Enfants Malades, 149 rue de Sèvres, Paris, France. JeanRalph.Zahar@chu-angers.fr.|Infection Control Unit, CHU d'Angers, 4 rue Larrey, 49100, Angers, France. JeanRalph.Zahar@chu-angers.fr.
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
mesh_terms: D000617:Aminoglycosides / Q000627:therapeutic use*; D002648:Child; D054869:Clinical Audit; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000617:Aminoglycosides
keywords: Aminoglycosides; Audit; Information campaign; Pediatrics