Agreement between units of measure for paediatric antibiotic utilisation surveillance using hospital pharmacy supply data
Background: Drug utilisation studies from paediatric hospitals that do not have access to patient level data on medication use are limited by a lack of standardised units of measures that reflect the varying daily dosage requirements among patients. The World Health Organization’s defined daily dose is frequently used in adult hospitals for benchmarking and longitudinal analysis but is not endorsed for use in paediatric populations.
Objective: Explore agreement between standard adult-based defined daily doses (DDD) and paediatric estimates of daily injectable antibiotic use in a Paediatric Intensive Care Unit that does not have access to individual patient-level data.
Methods: Hospital pharmacy antibiotic use reports and age-specific occupied bed-day data from 1 January 2010 to 31 May 2016 were extracted. Paediatric reference dosages and frequencies for antibiotics were defined and applied to three paediatric units of measure. Measures were applied to extracted data, agreement between antibiotic use measured in the adult DDD and each of the paediatric measures was assessed visually via Bland-Altman plots and linear regression for each antibiotic.
Results: Thirty one different antibiotics were used throughout the study period. Despite varying daily dosages in grams, the daily use of vials was unchanged from birth to 18 years for thirteen antibiotics. Agreement between DDD and vial-based measures was closer than the total recommended daily dose that did not account for wastage during preparation and administration. Vial-based measures were unaffected by vial size changes due to drug shortage.
Conclusions: Agreement between the DDD and vial-based measures of use supports the use of DDD for select antibiotics that may be targeted by antimicrobial stewardship programs. Vial based measures should be further explored in hospitals with single vial policies; detailed understanding of hospital practice is needed before inter-hospital comparisons are made.
Australian Commission on Safety and Quality in Health Care (ACSQHC). AURA 2017: Second Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC; 2017.
World Health Organization Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment. Oslo: WHOCC; 2018.
Liem TB, Heerdink ER, Egberts AC, Rademaker CM. Quantifying antibiotic use in paediatrics: a proposal for neonatal DDDs. Eur J Clin Microbiol Infect Dis. 2010;29(10):1301-1303. https://doi.org/10.1007/s10096-010-0990-3
SA Health. National Antimicrobial Utilisation Surveillance Program (NAUSP). Adelaide: SA Health; 2017. Available at: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs/antimicrobial+stewardship/national+antimicrobial+utilisation+surveillance+program+nausp (accessed Mar 2, 2019).
Australian Commission on Safety and Quality in Health Care (ACSQHC). Standard 3: Preventing and Controlling Healthcare Associated Infections. National Safety and Quality Health Service Standards. Sydney: ACSQHC; 2012.
MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev. 2005;18(4):638-656. https://doi.org/10.1128/CMR.18.4.638-656.2005
Fortin É, Fontela PS, Manges AR, Platt RW, Buckeridge DL, Quach C. Measuring antimicrobial use in hospitalized patients: a systematic review of available measures applicable to paediatrics. J Antimicrob Chemother. 2014;69(6):1447-1456. https://doi.org/10.1093/jac/dku003
Raastad R, Tvete IF, Abrahamsen TG, Berild D, Leegaard TM, Walberg M, Müller F. A worrying trend in weight-adjusted paediatric antibiotic use in a Norwegian tertiary care hospital. Acta Paediatr. 2015;104(7):687-692. https://doi.org/10.1111/apa.12994
NSW Ministry of Health. Medication Handling in NSW Public Health Facilities. Policy Directive (PD2013_043) Sydney, NSW: NSW Health; 2013. Available at: http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_043.pdf (accessed 20 Jan, 2018)
World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) :Structure and principles. Oslo: WHO; 2016.
Australian Medicines Handbook. Australian Medicines Handbook Children's Dosing Companion. Adelaide: Australian Medicines Handbook PTY; 2018.
Neonatal Medicines Formulary (NMF) Consensus Group. Newborn Care Centre Clinical resources – Medications. Neomed Formularies. Sydney, NSW. Available at: https://www.seslhd.health.nsw.gov.au/royal-hospital-for-women/australasian-neonatal-medicines-formulary-anmf (accessed Mar 2, 2019).
American Pharmaceutical Association (APA). Lexi-Comp Online in UptoDate. Hudson, Ohio: APA; 2017.
Paediatric Formulary Committee. British National Formulary for Children. London: BMJ Group and Royal Pharmacuetical Press; 2017.
Centers for Disease Control and Prevention(CDC). Clinical Growth Charts. Atlanta (GA) CDC. Available from: https://www.cdc.gov/growthcharts/cdc_charts.htm (accessed Mar 2, 2019).
Bland JM, Altman DG. Measuring Agreement in Method Comparison Studies. Stat Methods Med Res. 1999;8(2):135-160. https://doi.org/10.1177/096228029900800204
Antachopoulos C, Dotis J, Pentsioglou V. Development of a paediatric daily defined dose system for the measurement of antibiotic consumption in paediatric units. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague (Czech Republic); 2004.
Zou XX, Fang Z, Min R, Bai X, Zhang Y, Xu D, Fang PQ.Is nationwide special campaign on antibiotic stewardship program effective on ameliorating irrational antibiotic use in China? Study on the antibiotic use of specialized hospitals in China in 2011–2012. J Huazhong Univ Sci Technolog Med Sci. 2014;34(3):456-463. https://doi.org/10.1007/s11596-014-1300-6
Zhang W, Shen X, Bergman U, Wang Y, Chen Y, Huang M, Zeng Q, Wei J, Lu Q, Wang G, Deng L, Wang X, Yao K, Yu S, Yang Y. Drug utilisation 90% (DU90%) profiles of antibiotics in five Chinese children's hospitals (2002-2006). Int J Antimicrob Agents. 2008;32(3):250-255. https://doi.org/10.1016/j.ijantimicag.2008.04.007
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