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Rational Use of Medicines in Neonates: Current Observations, Areas for Research and Perspectives
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Rational Use of Antibiotics in Neonates: Still in Search of Tailored Tools

1
Division of Clinical Pharmacology, Department of Pediatrics, Children’s National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
2
Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
3
Intensive Care, Erasmus MC-Sophia Children’s Hospital, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
4
Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s Hospital, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
5
Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
*
Author to whom correspondence should be addressed.
Healthcare 2019, 7(1), 28; https://doi.org/10.3390/healthcare7010028
Received: 12 January 2019 / Revised: 31 January 2019 / Accepted: 14 February 2019 / Published: 16 February 2019
(This article belongs to the Special Issue Rational Use of Medicines in Children)
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Abstract

Rational medicine use in neonates implies the prescription and administration of age-appropriate drug formulations, selecting the most efficacious and safe dose, all based on accurate information on the drug and its indications in neonates. This review illustrates that important uncertainties still exist concerning the different aspects (when, what, how) of rational antibiotic use in neonates. Decisions when to prescribe antibiotics are still not based on robust decision tools. Choices (what) on empiric antibiotic regimens should depend on the anticipated pathogens, and the available information on the efficacy and safety of these drugs. Major progress has been made on how (beta-lactam antibiotics, aminoglycosides, vancomycin, route and duration) to dose. Progress to improve rational antibiotic use necessitates further understanding of neonatal pharmacology (short- and long-term safety, pharmacokinetics, duration and route) and the use of tailored tools and smarter practices (biomarkers, screening for colonization, and advanced therapeutic drug monitoring techniques). Implementation strategies should not only facilitate access to knowledge and guidelines, but should also consider the most effective strategies (‘skills’) and psychosocial aspects involved in the prescription process: we should be aware that both the decision not to prescribe as well as the decision to prescribe antibiotics is associated with risks and benefits. View Full-Text
Keywords: newborn; rational drug use; antibiotics; safety; stewardship newborn; rational drug use; antibiotics; safety; stewardship
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van den Anker, J.; Allegaert, K. Rational Use of Antibiotics in Neonates: Still in Search of Tailored Tools. Healthcare 2019, 7, 28.

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