{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T01:02:57Z","timestamp":1789347777586,"version":"build-2803163510"},"reference-count":40,"publisher":"American Academy of Pediatrics (AAP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Beta-lactam therapeutic drug monitoring (BL-TDM) is underused in pediatric patients where drug exposure is highly variable. This study evaluated the pharmacokinetic\/pharmacodynamic (PK\/PD) target attainment of BLs in pediatrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PATIENTS AND METHODS<\/jats:title>\n                    <jats:p>A retrospective observational cohort study of BL-TDM was conducted from 2016 to 2023 in hospitalized patients aged 18\u00a0years and younger receiving ampicillin, aztreonam, cefazolin, cefepime, ceftriaxone, imipenem, meropenem, oxacillin, or piperacillin with available plasma concentrations. Two PK\/PD targets were assessed: 100%fT \u2265 minimum inhibitory concentration (MIC) and 100% fT \u2265 4\u2009\u00d7\u2009MIC. Clinical and microbiological success were evaluated as exploratory endpoints in relation to target attainment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 142 BL-TDM events (122 patients, 129 hospital encounters), 69% achieved 100% fT \u2265 MIC, whereas 41.5% attained 100% fT \u2265 4\u2009\u00d7\u2009MIC. Median age was 11\u00a0years (IQR, 1\u201317). Ninety-nine hospital encounters (76.7%) included an intensive care unit admission. Cefepime and meropenem were the most common BLs with available concentrations. Ampicillin and meropenem were among the BLs achieving the highest PK\/PD target attainment at 88.9% and 71.4% for 100%fT \u2265 MIC and 77.8% and 62.9% for 100%fT \u2265 4 \u00d7 MIC. Dose adjustments were made in 31% of BLs, with either a switch to continuous infusion or an increase in the daily dose being the most frequently implemented. In the exploratory secondary analysis, clinical and microbiological success rates were high regardless of target attainment. A higher estimated glomerular filtration rate within 24\u00a0hours of TDM and younger age were independently associated with target non-attainment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Over half of all patients failed to achieve 100%fT \u2265 4 \u00d7 MIC with standard BL regimens. Furthermore, dosing adjustments made in nearly one-third of cases further emphasizes BL-TDM\u2019s role in individualizing pediatric dosing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/hpeds.2025-008993","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:03:17Z","timestamp":1789344197000},"source":"Crossref","is-referenced-by-count":0,"title":["Beta-Lactam Dose Optimization Using Therapeutic Drug Monitoring in Pediatric Patients"],"prefix":"10.1542","author":[{"given":"Veena","family":"Venugopalan","sequence":"first","affiliation":[{"name":"1Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida"},{"name":"2Department of Pharmacy Education and Practice, University of Florida College of Pharmacy, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalen B.","family":"Manasco","sequence":"additional","affiliation":[{"name":"1Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida"},{"name":"2Department of Pharmacy Education and Practice, University of Florida College of Pharmacy, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Hachem","sequence":"additional","affiliation":[{"name":"3Department of Medicine, UF Health Shands Hospital, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanzhi","family":"Gao","sequence":"additional","affiliation":[{"name":"4Department of Biostatistics, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Cui","sequence":"additional","affiliation":[{"name":"4Department of Biostatistics, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances M.","family":"Saccoccio","sequence":"additional","affiliation":[{"name":"5Children\u2019s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"issue":"2","key":"2026091320031095300_r1","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1038\/s41390-021-01878-9","article-title":"Antibiotics in critically ill children-a narrative review on different aspects of a rational approach","volume":"91","author":"Bruns","year":"2022","journal-title":"Pediatr Res."},{"issue":"10","key":"2026091320031095300_r2","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.3390\/antibiotics10101182","article-title":"Pharmacokinetics of antibiotics in pediatric intensive care: fostering variability to attain precision medicine","volume":"10","author":"Gijsen","year":"2021","journal-title":"Antibiotics (Basel)."},{"issue":"2","key":"2026091320031095300_r3","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1097\/CCM.0000000000002817","article-title":"\u03b2-lactam therapeutic drug management in the PICU","volume":"46","author":"Cies","year":"2018","journal-title":"Crit Care Med."},{"issue":"11","key":"2026091320031095300_r4","doi-asserted-by":"crossref","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit Care Med."},{"issue":"10","key":"2026091320031095300_r5","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1093\/cid\/ciac506","article-title":"Beta-lactam antibiotic therapeutic drug monitoring in critically ill patients: a systematic review and meta-analysis","volume":"75","author":"Pai Mangalore","year":"2022","journal-title":"Clin Infect Dis."},{"issue":"1","key":"2026091320031095300_r6","doi-asserted-by":"crossref","first-page":"7793","DOI":"10.1038\/s41598-024-58200-w","article-title":"Assessment of the practical impact of adjusting beta-lactam dosages based on therapeutic drug monitoring in critically ill adult patients: a systematic review and meta-analysis of randomized clinical trials and observational studies","volume":"14","author":"Guly\u00e1s","year":"2024","journal-title":"Sci Rep."},{"key":"2026091320031095300_r7","doi-asserted-by":"crossref","first-page":"1044683","DOI":"10.3389\/fphar.2022.1044683","article-title":"\u03b2-lactam precision dosing in critically ill children: current state and knowledge gaps","volume":"13","author":"Tang Girdwood","year":"2022","journal-title":"Front Pharmacol."},{"key":"2026091320031095300_r8","doi-asserted-by":"crossref","first-page":"777854","DOI":"10.3389\/fped.2022.777854","article-title":"Beta-lactams therapeutic monitoring in septic children: what target are we aiming for? 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