Abstract
Background Incorrect dosing is the most frequent prescribing error in neonatology, with antibiotics being the most frequently prescribed medicines. Computer physician order entry and clinical decision support systems can create consistency contributing to a reduction of medication errors. Although evidence-based dosing recommendations should be included in such systems, the evidence is not always available and subsequently, dosing recommendations mentioned in guidelines and textbooks are often based on expert opinion. Objective To compare dosage recommendations for antibiotics in neonates with sepsis provided by eight commonly used and well-established international reference sources. Setting An expert team from our Dutch tertiary care neonatal intensive care unit selected eight well-established international reference sources. Method Daily doses of the seven most frequently used antibiotics in the treatment of neonatal sepsis, classified by categories for birth weight and gestational age, were identified from eight well-respected reference sources in neonatology/pediatric infectious diseases. Main outcome measure Standardized average daily dosage. Results A substantial variation in dosage recommendations of antibiotics for neonatal sepsis between the reference sources was shown. Dosage recommendations of ampicillin, ceftazidime, meropenem and vancomycin varied more than recommendations for benzylpenicillin, cefotaxime and gentamicin. One reference source showed a larger variation in dosage recommendations in comparison to the average recommended daily dosage, compared to the other reference sources. Conclusion Antibiotic dosage recommendations for neonates with sepsis can be derived from important reference sources and guidelines. Further exploration to overcome variation in dosage recommendations is necessary to obtain standardized dosage regimens.
Highlights
MethodThe most common medication error in neonates is incorrect dosing due to lack of evidence or lack of access to the available evidence at the moment of prescribing [1]
A multicentre study on paediatric antimicrobial prescribing in European hospitals demonstrated that the prescribed daily dose (PDD) in children increased with age and weight
The Summaries of Product Characteristics (SmPCs) of the concerning antibiotics were evaluated when specific dosage recommendations for neonatal sepsis were available. These neonatal dosage recommendations were explicitly available in the SmPC of cefotaxime and gentamicin exclusively, which might be an explanation for the smaller variation in dosage recommendations between the evaluated reference sources for these two antibiotics compared to ampicillin, ceftazidime, meropenem and vancomycin
Summary
MethodThe most common medication error in neonates is incorrect dosing due to lack of evidence or lack of access to the available evidence at the moment of prescribing [1]. Computer physician order entry (CPOE) and clinical decision support systems can contribute to the reduction of such medication errors and thereby increase patient safety [2]. A multicentre study on paediatric antimicrobial prescribing in European hospitals demonstrated that the prescribed daily dose (PDD) in children increased with age and weight. This advocates the need to define standardized paediatric daily doses for different paediatric age groups and neonates separately [4]. Computer physician order entry and clinical decision support systems can create consistency contributing to a reduction of medication errors. Evidence-based dosing recommendations should be included in such systems, the evidence is not always available and subsequently, dosing recommendations mentioned in guidelines and textbooks are often based on expert opinion
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