USE OF ANTIBIOTICS IN THE PEDIATRIC INTENSIVE CARE UNIT

Antibiotici su najčešće propisivani lijekovi u kliničkoj praksi. Njihova uporaba posebno je izražena u pedijatrijskim jedinicama intenzivnog liječenja gdje se liječe životno ugrožena djeca. Prilikom primjene lijekova važno je prilagoditi doze lijekova dobi i stanju djeteta te uzeti u obzir razlike koje postoje u odnosu na odrasle (ponajviše u farmakokinetici). U pedijatrijskoj intenzivnoj jedinici se antibiotici najčešće koriste empirijski. Kako uzročnik još nije poznat, koriste se antibiotici širokog spektra. Oni djeluju na više vrsta bakterija: gram pozitivne, gram negativne, aerobne, anaerobne, kako na one patogene, tako i na fiziološku floru. Njihovu uporabu treba maksimalno skratiti te ih što prije zamijeniti antibioticima uskog spektra djelovanja. Zbog neracionalne primjene razvila se rezistencija koja je postala globalni problem u liječenju bakterijskih infekcija. S obzirom na to da ne postoji protokol koji bi optimizirao uporabu antibiotika, započelo je osnivanje bolničkih programa praćenja antimikrobnih lijekova kojima je cilj racionalizirati korištenje antibiotika i smanjiti daljnji razvoj rezistencije.
Antibiotics are the most used drugs in clinical practise. Their use is particularly important in pediatric intensive care units where children with life-threatening conditions are treated. When using drugs, it is important to adjust the dose of the medication to the age and condition of the child and to consider the differences that exist in relation to adults (mostly in pharmacokinetics). In the pediatric intensive care unit antibiotics are most frequently used empirically. Since the causative agent is not yet known, broad spectrum antibiotics are used. They act on several types of bacteria: gram positive, gram negative, aerobes, anaerobes, but apart from pathogens, they also act on the physiological flora. Their use should be maximally shortened and replaced as soon as possible with narrow range spectrum antibiotics. Because of irrational use, resistance of bacteria has developed. It has become a global problem in the treatment of bacterial infections. Given that there is no protocol to optimize the use of antibiotics, Antimicrobial Stewardship Programs have been introduced to rationalize the use of antibiotics and reduce further resistance development.