308 Comparison of Antibiotic Dosing Recommendations for Neonates From Common References

Abstract

Background and aims: Computer physician order entry (CPOE) and clinical decision support systems contribute to the reduction of medication errors. Although evidence-based dosing should be included in the systems, data are not always available and dosing is based on expert opinion, derived from guidelines and textbooks. To define a gold standard for neonatal antibiotic dosages, we compared recommendations provided by international reference sources. Methods: Neonatal daily doses for the 12 most frequently used antibiotics were identified from 7 well-respected references (Nelson's, British National Formulary for Children, Pediatric Dosage Handbook, Redbook, etc). The average daily dosage (ADD) was calculated, as well as the relative deviation Rd = (DDmax -DDmin)/ADD *100%. Results: The sources provided recommendations for neonatal sepsis (n = 7), meningitis (n = 7), and necrotizing enterocolitis (n = 1). The dosing recommendations of amoxicillin, ampicillin, amoxicillin-clavulanic acid, flucloxacillin, meropenem, gentamicin, vancomycin, erythromycin, cefotaxime and rifampicin did not show clinically relevant differences (Rd< 50%). Dosing recommendations for benzylpenicillin and ceftazidim showed major variation between sources (Rd = 75% and Rd = 68%, respectively). Conclusions: Gold standard, expert opinion antibiotic dosage recommendations for neonates can be derived from important textbooks and guidelines for most, but not all antibiotics. To obtain full benefit of CPOE and clinical decision support systems in neonatology, further exploration to overcome guideline variations is necessary. Uniformity in neonatal dosage recommendations of antibiotics can also serve as a basis for developing a set of neonatal defined daily doses (nDDDs), a valuable tool for analysis of drug consumption.