Antibiotic Dosing Considerations for Term and Preterm Infants
Early and appropriate antibiotic therapy can be lifesaving for severe infections in infants. However, physiologic differences in infants compared with older children and adults contribute to challenges in neonatal dosing. Neonatal-specific dosing regimens may be derived by pharmacokinetic modeling and simulation techniques. However, these techniques have resulted in disparate dosing recommendations for certain antibiotic therapies. Herein, we describe existing controversies for dosing-based measures of renal and hepatic growth, maturation, and function during the neonatal period. We detail existing data, risks, and benefits of alternate-interval dosing regimens in neonatal populations and provide considerations for adequate penetration of the blood–brain barrier and optimization of perioperative antibiotic management. Finally, we provide recommendations on dosing in critically ill infants supported with extracorporeal membrane oxygenation or receiving therapeutic hypothermia. Future studies should seek to identify the most appropriate measures of organ growth and maturation and establish appropriate antibiotic dosing recommendations to maximize bacterial killing and minimize toxicity.
