Optimizing the Use of Antibiotic Agents in the Pediatric Intensive Care Unit: A Narrative Review

Abstract

Antibiotics are one of the most prescribed drug classes in the pediatric intensive care unit, yet the incidence of inappropriate antibiotic prescribing remains high in critically ill children. Optimizing the use of antibiotics in this population is imperative to guarantee adequate treatment, avoid toxicity and the occurrence of antibiotic resistance, both on a patient level and on a population level. Antibiotic stewardship encompasses all initiatives to promote responsible antibiotic usage and the PICU represents a major target environment for antibiotic stewardship programs. This narrative review provides a summary of the available knowledge on the optimal selection, duration, dosage, and route of administration of antibiotic treatment in critically ill children. Overall, more scientific evidence on how to optimize antibiotic treatment is warranted in this population. We also give our personal expert opinion on research priorities.

Fig. 1

Pathophysiological and treatment-induced alterations in critical illness that may impact antibiotic pharmacokinetics. CYP450 cytochrome P450, GFR glomerular filtration rate

Fig. 2

Pharmacokinetic/pharmacodynamic parameters of antibiotics. AUC area under the curve, C_max peak drug concentration, MIC minimum inhibitory concentration, T time