Optimal Anti-infective Drug Doses for Children

OPTIMAL ANTI-INFECTIVE DRUG DOSES FOR CHILDREN Anti-infective agents are among the most commonly prescribed drugs in children. What is considered the optimal dose of an anti-infective agent is determined by how the child handles the drug and the resulting drug concentration in the body (pharmacokinetics, PK) as well as by the effect of the drug on the target pathogen (pharmacodynamics, PD). Among pediatric patients, considerable PK differences exist, including agerelated variation in drug absorption, distribution, protein binding, metabolism and elimination. For many anti-infective agents, there is therefore no direct evidence for pediatric dosing recommendations and, as a consequence, adult-based dose recommendations are modified based on body weight or surface area. This may be an oversimplified approach, as it fails to account for many key maturational and developmental changes that influence drug concentrations and ultimately efficacy of treatment (Fig. 1). In addition, there are a number of specific patient groups, including individuals with cystic fibrosis, critical illness, obesity and immunocompromise, as well as preterm and term neonates for whom PK and PD properties are even more complex.