Demonstrating Feasibility of an Opportunistic Sampling Approach for Pharmacokinetic Studies of ß-Lactam Antibiotics in Critically Ill Children.

There has been increasing interest in incorporating ß-lactam precision dosing into routine clinical care, but robust population pharmacokinetic models in critically ill children are needed for these purposes. The objective of this study was to demonstrate the feasibility of an opportunistic sampling approach that utilizes scavenged residual blood for future pharmacokinetic studies of cefepime, meropenem, and piperacillin. We aimed to show that opportunistic samples would cover the full concentration-versus-time profiles and to evaluate stability of the antibiotics in whole blood and plasma to optimize future use of the opportunistic sampling approach. A prospective observational study was conducted in a single-center pediatric intensive care unit, where pediatric patients administered at least 1 dose of cefepime, meropenem, or piperacillin/tazobactam and who had residual blood scavenged from samples obtained for routine clinical care were enrolled. A total of 138 samples from 22 pediatric patients were collected in a 2-week period. For all 3 antibiotics, the samples collected covered the entire dosing intervals and were not clustered around specific times. There was high variability in the free concentrations and in the percentage of drug bound to protein. There was less than 15% degradation for meropenem or piperacillin when stored in whole blood or plasma at 4°C after 6 days. Cefepime degraded by more than 15% after 3 days. The opportunistic sampling approach is a powerful and feasible method to obtain sufficient samples to study the variability of drug concentrations and protein binding for future pharmacokinetic studies in the pediatric critical care population.

Route of Oseltamivir Administration Affects Metabolite Concentrations in Critically Ill Children.

We performed a prospective cohort study to investigate oseltamivir administration in critically ill children. We found that enteric tube administration of oseltamivir resulted in lower concentrations of its active metabolite compared with oral delivery. These findings could have significant clinical implications, and more studies are required to better understand the effects of administration route on potential lower systemic metabolite exposure.

Comparison of an interviewer-administered with an automated self-administered 24 h (ASA24) dietary recall in adolescents.

OBJECTIVE: The current pilot study aimed to assess whether reporting quality would decline materially in adolescents completing weekly web-based Automated Self-Administered 24-Hour dietary recalls (ASA24-Kids-2014) and interviewer-administered 24 h dietary recalls for six weeks. We also aimed to assess method preference. DESIGN: We conducted two studies. Study 1 (n 20) randomized participants to complete either one ASA24-Kids-2014 or one interviewer-administered recall weekly, for six weeks. Energy intake and number of foods reported were described for each method over time. Differences between recall methods for each measure were tested using mixed-effects regression. Study 2 (n 10) employed a randomized crossover design to describe method preference. SETTING: Dietary intake was collected either by telephone (interviewer-administered dietary recalls) or via the Internet (ASA24-Kids-2014 dietary recalls). SUBJECTS: Adolescents aged 12-17 years with no prior diet recording experience were enrolled. RESULTS: In Study 1, mean (sd) total energy and number of foods reported decreased by 50 (222) kJ (12 (53) kcal) and 0·05 (0·31) items v. 38 (138) kJ (9 (33) kcal) and 0·17 (0·14) items per recall for participants randomized to the ASA24-Kids-2014 v. interviewer-administered recalls, respectively. There was no difference between groups for either measure (P > 0·57). In Study 2, eight of ten participants preferred the interviewer-administered recall over the ASA24-Kids-2014. Overall, seven of twenty participants experienced technical difficulties with the ASA24-Kids-2014. CONCLUSIONS: No appreciable decay in reporting quality was seen for either method. However, participants reported a preference for the interviewer-administered recall. Our findings can help inform and support larger studies to further characterize the performance of the ASA24 in adolescents.