Pharmacokinetics optimization of antimicrobials: a stewardship approach for pediatric patients with pneumonia and hypoalbuminemia
DOI:
https://doi.org/10.30968/jhphs.2025.162.1314Abstract
Objective: To evaluate whether pharmacokinetic optimization of beta-lactam antibiotics highly bound to plasma proteins prevent escalation to broader-spectrum antibiotics in pediatric patients with complicated CAP. Methods: Retrospective cohort study in a pediatric tertiary hospital, involving patients with complicated CAP treated with optimized doses of ceftriaxone and/or oxacillin, monitored by the antimicrobial stewardship program between 2023 and 2024. Patients admitted to the wards were included, excluding those in ICUs, hemato-oncology or with treatment time less than 48 hours. Data were collected from clinical records and analyzed using SPSS v2.0, including descriptive analyses (means, standard deviation, frequencies) and inferential tests (Mann-Whitney, Student’s t-test, Chi-Square/Fisher, p<0.05). The outcomes evaluated were clinical/microbiological cure, treatment failure, and augmented renal clearance. The study followed the STROBE guidelines and was approved by the Ethics Committee (CAAE: 77560624.9.0000.0097). Results: The sample included 53 patients, of which 96.2% had complicated CAP, high prevalence of hypoalbuminemia (92.5%) and augmented renal clearance (91.3%). There was a significant reduction in escalation in 2024 (from 48.3% to 8.3%; p=0.001), decreased in the time to intervention for therapy optimization (5th vs. 3rd day, p=0.004), and reduction in total treatment duration (12.2 vs. 9.5 days, p=0.011) after protocol implementation. No adverse reactions occurred, and clinical cure without escalation was observed in 69.8% of patients. Conclusion: Pharmacokinetic optimization of beta-lactam antibiotics was effective in reducing escalation in patients with complicated CAP. The pharmacist’s role in stewardship, contributed to better clinical outcomes and safety, with positive impacts on clinical practice and adherence to the protocol.
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