title: Optimizing Guideline-Recommended Antibiotic Doses for Pediatric Infective Endocarditis.
abstract: The American Heart Association recently published an updated scientific statement on the management of infective endocarditis in childhood. The recommendations included for vancomycin, aminoglycoside, and β-lactam dosing and monitoring are based primarily on expert opinion and do not consider available evidence for dose optimization based on pharmacokinetic and pharmacodynamic principles in pediatric patients. This is concerning because even when clinically necessary, some practitioners may be hesitant to deviate from guideline-recommended doses. In this perspective, we highlight potential areas for improvement in the statement-recommended doses and summarize evidence supporting antibiotic dosing optimization. The addition of a pediatric clinical pharmacist with expertise in antibiotic dosing to the panel would be beneficial for future updates.
authors.affiliation: Butler University, Indianapolis, IN, USA Indiana University Health, Indianapolis, IN, USA Indiana University School of Medicine, Indianapolis, IN, USA knichols@butler.edu.
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Nichols
authors.affiliation: Indiana University Health, Indianapolis, IN, USA Purdue University, Indianapolis and West Lafayette, IN, USA.
authors.forename: Emily N
authors.initials: EN
authors.lastname: Israel
authors.affiliation: Indiana University Health, Indianapolis, IN, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Thomas
authors.affiliation: Butler University, Indianapolis, IN, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Knoderer
mesh_terms: D000617:Aminoglycosides / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D014481:United States; D014640:Vancomycin / Q000008:administration & dosage; D047090:beta-Lactams / Q000008:administration & dosage
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D014640:Vancomycin
keywords: aminoglycosides; antibiotics; clinical practice guidelines; endocarditis; infectious disease; pediatrics; pharmacodynamics; vancomycin