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This British Medical Journal (BMJ) 'feature' provides an overview of the limited evidence behind the oral penicillin dosing regimes recommended in the BNFC. The study also explores the evidence for potential underdosing of antimicrobials in many children today that may result from the use of age brackets rather than weight brackets for dosing decisions, in an age of increasing childhood obesity
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Ahmed U, Spyridis N, Wong IC, et al. Dosing of oral penicillins in children: Is big child = half an adult, small child=half a big child, baby = half a small child still the best we can do? BMJ 2011; 343:d7803. This British Medical Journal (BMJ) 'feature' provides an overview of the limited evidence behind the oral penicillin dosing regimes recommended in the BNFC. The study also explores the evidence for potential underdosing of antimicrobials in many children today that may result from the use of age brackets rather than weight brackets for dosing decisions, in an age of increasing childhood obesity.
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The role of population PK-PD modelling in paediatric clinical research
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This review explores the role of paediatric population PK/PD studies with reference to nonlinear mixed effect modelling, allowing analysis of sparse and unbalanced datasets. The review also discusses evaluation of the predictive performance of these models by different validation methods including prospective clinical trials and how to optimize the design of paediatric studies
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De Cock RF, Piana C, Krekels EH, et al. The role of population PK-PD modelling in paediatric clinical research. Eur J Clin Pharmacol 2011; 67 (Suppl 1):5-16. This review explores the role of paediatric population PK/PD studies with reference to nonlinear mixed effect modelling, allowing analysis of sparse and unbalanced datasets. The review also discusses evaluation of the predictive performance of these models by different validation methods including prospective clinical trials and how to optimize the design of paediatric studies.
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Jacobs MR. Optimisation of antimicrobial therapy using pharmacokinetic and pharmacodynamic parameters. Clin Microbiol Infect 2001; 7:589-596.
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Conserving antibiotics for the future: New ways to use old and new drugs from a pharmacokinetic and pharmacodynamic perspective
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This study presents an excellent insight into the rational use of PK/PDdata to optimize antimicrobial dosing regimens, with specific focus on achieving the requisite microbiological and clinical outcomes while simultaneously suppressing emergence of resistance. The application of PK/PD to drug development is considered, as is the need to urgently establish the PK/PD profiles of older antibiotics
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Mouton JW, Ambrose PG, Canton R, et al. Conserving antibiotics for the future: New ways to use old and new drugs from a pharmacokinetic and pharmacodynamic perspective. Drug Resist Updat 2011; 14:107-117. This study presents an excellent insight into the rational use of PK/PDdata to optimize antimicrobial dosing regimens, with specific focus on achieving the requisite microbiological and clinical outcomes while simultaneously suppressing emergence of resistance. The application of PK/PD to drug development is considered, as is the need to urgently establish the PK/PD profiles of older antibiotics.
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Mouton, J.W.1
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Estimation of cefuroxime dosage using pharmacodynamic targets, MIC distributions, and minimization of a risk function
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Ribbing J, Jonsson EN. Power, selection bias and predictive performance of the population pharmacokinetic covariate model. J Pharmacokinet Pharmacodyn 2004; 31:109-134.
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Standing JF, Hammer GB, Sam WJ, Drover DR. Pharmacokinetic- pharmacodynamic modeling of the hypotensive effect of remifentanil in infants undergoing cranioplasty. Pediatr Anesth 2010; 20:7-18.
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This study systematically reviewed observational cohort studies, case reports, and patient series regarding the use of ciprofloxacin in neonates; however, due to the heterogeneity of study designs and clinical contexts, no pooled analyses of outcomes were conducted. Although the findings provided someinformation to support the use of ciprofloxacin in neonates, additional high-quality studies are warranted to further investigate the pharmacokinetics, efficacy, and long-term safety
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Kaguelidou F, Turner MA, Choonara I, Jacqz-Aigrain E. Ciprofloxacin use in neonates: A systematic review of the literature. Pediatr Infect Dis J 2011; 30:E29-E37. This study systematically reviewed observational cohort studies, case reports, and patient series regarding the use of ciprofloxacin in neonates; however, due to the heterogeneity of study designs and clinical contexts, no pooled analyses of outcomes were conducted. Although the findings provided someinformation to support the use of ciprofloxacin in neonates, additional high-quality studies are warranted to further investigate the pharmacokinetics, efficacy, and long-term safety.
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This pharmacokinetic meta-analysis comprised a pooled population analysis using nonlinear mixed effects modelling to define the pharmacokinetics of diclofenac in children administered by different routes, and to identify recommended routespecific dosing regimens. The meta-analysis shows the clinical relevance and potential patient benefit of using knowledge derived from well-designed pooled analyses of pharmacokinetic data
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Standing JF, Tibboel D, Korpela R, Olkkola KT. Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1-12 years. Pediatr Anesth 2011; 21:316-324. This pharmacokinetic meta-analysis comprised a pooled population analysis using nonlinear mixed effects modelling to define the pharmacokinetics of diclofenac in children administered by different routes, and to identify recommended routespecific dosing regimens. The meta-analysis shows the clinical relevance and potential patient benefit of using knowledge derived from well-designed pooled analyses of pharmacokinetic data.
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Pediatr Anesth
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A risk adapted approach to the governance of clinical trials
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In this BMJ editorial, researchers are encouraged to support the new risk-adapted approach to the regulation of clinical trials of investigational medicinal products: Trials using a product according to European Union-licensed indications (or offlabel use in a manner that is well established in clinical practice, e.g. in paediatric usage) need only be notified to the Medicines and Healthcare products Regulatory Agency (MHRA) and may proceed after 14 days from receipt of notification if the MHRA has not raised objections. This new initiative should be embraced, particularly in paediatric research, to facilitate proportionate regulation of clinical studies
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Smyth RL. A risk adapted approach to the governance of clinical trials. BMJ 2011; 343:d6756. In this BMJ editorial, researchers are encouraged to support the new risk-adapted approach to the regulation of clinical trials of investigational medicinal products: Trials using a product according to European Union-licensed indications (or offlabel use in a manner that is well established in clinical practice, e.g. in paediatric usage) need only be notified to the Medicines and Healthcare products Regulatory Agency (MHRA) and may proceed after 14 days from receipt of notification if the MHRA has not raised objections. This new initiative should be embraced, particularly in paediatric research, to facilitate proportionate regulation of clinical studies.
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42
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This prospective study investigated the pharmacokinetics of metronidazole in preterm neonates, using high-performance liquid chromatography on dried blood spots and nonlinear mixed effect modelling to define a new, more appropriate dosage regimen. The results demonstrated that the novel technique of dried blood spot-HPLC assay for the determination of metronidazole in neonatal whole blood samples could be used to develop and validate a new pharmacokinetic model
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