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Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study

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IWT SBO 130033: SAFE-PEDRUG: Integrating multidisciplinary translational bottom-up approaches towards a new paradigm for paedriatic investigations: the next step in ethical paediatric drug research
Abstract
Background: Fluoroquinolones (FQ) are increasingly prescribed for children, despite being labeled for only a limited number of labeled pediatric indications. In this multicenter retrospective drug utilization study, we analyzed indications for systemic FQ prescriptions in hospitalized children and the appropriateness of the prescribed dose. Methods: Using data obtained from electronic medical files, the study included all children who received a systemic FQ prescription in two Belgian university children's hospitals between 2010 and 2013. Two authors reviewed prescribed daily doses. Univariate and multivariate logistic regression models were used to analyze risk factors for inadequately dosing. Results262 FQ prescriptions for individual patients were included for analysis. 16.8% of these prescriptions were for labeled indications, and 35.1% were guided by bacteriological findings. Prescribed daily dose was considered to be inappropriate in 79 prescriptions (30.2%). Other FQ than ciprofloxacin accounted for 9 prescriptions (3.4%), of which 8 were correctly dosed. Underdosing represented 45 (56.9%) dosing errors. Infants and preschool children were at particular risk for dosing errors, with associated adjusted OR of 0.263 (0.097-0.701) and 0.254 (0.106-0.588) respectively. Conclusions: FQ were often prescribed off-label and not guided by bacteriological findings in our study population. Dosing errors were common, particularly in infants and preschool children. FQ prescriptions for children should be improved by specific pediatric antimicrobial stewardship teams. Furthermore, pharmacokinetic studies should optimise dosing recommendations for children.
Keywords
CEREBROSPINAL-FLUID PENETRATION, MYCOPLASMA-PNEUMONIAE, CIPROFLOXACIN, PROPHYLAXIS, MENINGITIS, PEDIATRICS, INFECTION, SAFETY, PHARMACOKINETICS, OFLOXACIN, Fluoroquinolones, Children, Drug utilization study, Off-label, prescribing, Prescription errors, Antimicrobial stewardship

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Citation

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MLA
Meesters, Kevin et al. “Systemic Fluoroquinolone Prescriptions for Hospitalized Children in Belgium, Results of a Multicenter Retrospective Drug Utilization Study.” BMC INFECTIOUS DISEASES 18 (2018): n. pag. Print.
APA
Meesters, K., MAUEL, R., Dhont, E., Vande Walle, J., & De Bruyne, P. (2018). Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study. BMC INFECTIOUS DISEASES, 18.
Chicago author-date
Meesters, Kevin, REINER MAUEL, Evelyn Dhont, Johan Vande Walle, and Pauline De Bruyne. 2018. “Systemic Fluoroquinolone Prescriptions for Hospitalized Children in Belgium, Results of a Multicenter Retrospective Drug Utilization Study.” Bmc Infectious Diseases 18.
Chicago author-date (all authors)
Meesters, Kevin, REINER MAUEL, Evelyn Dhont, Johan Vande Walle, and Pauline De Bruyne. 2018. “Systemic Fluoroquinolone Prescriptions for Hospitalized Children in Belgium, Results of a Multicenter Retrospective Drug Utilization Study.” Bmc Infectious Diseases 18.
Vancouver
1.
Meesters K, MAUEL R, Dhont E, Vande Walle J, De Bruyne P. Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study. BMC INFECTIOUS DISEASES. 2018;18.
IEEE
[1]
K. Meesters, R. MAUEL, E. Dhont, J. Vande Walle, and P. De Bruyne, “Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study,” BMC INFECTIOUS DISEASES, vol. 18, 2018.
@article{8555769,
  abstract     = {Background: Fluoroquinolones (FQ) are increasingly prescribed for children, despite being labeled for only a limited number of labeled pediatric indications. In this multicenter retrospective drug utilization study, we analyzed indications for systemic FQ prescriptions in hospitalized children and the appropriateness of the prescribed dose. 
Methods: Using data obtained from electronic medical files, the study included all children who received a systemic FQ prescription in two Belgian university children's hospitals between 2010 and 2013. Two authors reviewed prescribed daily doses. Univariate and multivariate logistic regression models were used to analyze risk factors for inadequately dosing. Results262 FQ prescriptions for individual patients were included for analysis. 16.8% of these prescriptions were for labeled indications, and 35.1% were guided by bacteriological findings. Prescribed daily dose was considered to be inappropriate in 79 prescriptions (30.2%). Other FQ than ciprofloxacin accounted for 9 prescriptions (3.4%), of which 8 were correctly dosed. Underdosing represented 45 (56.9%) dosing errors. Infants and preschool children were at particular risk for dosing errors, with associated adjusted OR of 0.263 (0.097-0.701) and 0.254 (0.106-0.588) respectively. 
Conclusions: FQ were often prescribed off-label and not guided by bacteriological findings in our study population. Dosing errors were common, particularly in infants and preschool children. FQ prescriptions for children should be improved by specific pediatric antimicrobial stewardship teams. Furthermore, pharmacokinetic studies should optimise dosing recommendations for children.},
  articleno    = {89},
  author       = {Meesters, Kevin and MAUEL, REINER and Dhont, Evelyn and Vande Walle, Johan and De Bruyne, Pauline},
  issn         = {1471-2334},
  journal      = {BMC INFECTIOUS DISEASES},
  keywords     = {CEREBROSPINAL-FLUID PENETRATION,MYCOPLASMA-PNEUMONIAE,CIPROFLOXACIN,PROPHYLAXIS,MENINGITIS,PEDIATRICS,INFECTION,SAFETY,PHARMACOKINETICS,OFLOXACIN,Fluoroquinolones,Children,Drug utilization study,Off-label,prescribing,Prescription errors,Antimicrobial stewardship},
  language     = {eng},
  pages        = {8},
  title        = {Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study},
  url          = {http://dx.doi.org/10.1186/s12879-018-2994-z},
  volume       = {18},
  year         = {2018},
}

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