---
title: "Beta-Lactam Therapeutic Drug Monitoring for Pediatric Dose Optimization"
id: "pubmed-42732892"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42732892"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42732892/"
doi: "10.1542/hpeds.2025-008993"
published_at: "2026-09-14T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Beta-Lactam Therapeutic Drug Monitoring for Pediatric Dose Optimization
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42732892
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42732892/)
- **DOI:** [10.1542/hpeds.2025-008993](https://doi.org/10.1542%2Fhpeds.2025-008993)
- **Published At:** 2026-09-14T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective cohort study evaluated **beta-lactam therapeutic drug monitoring (BL-TDM)** in hospitalized pediatric patients from 2016–2023 to assess pharmacokinetic/pharmacodynamic (PK/PD) target attainment. - Patients included were ≤18 years receiving ampicillin, aztreonam, cefazolin, cefepime, ceftriaxone, imipenem, meropenem, oxacillin, or piperacillin with available plasma concentrations. - Two PK/PD targets were evaluated: **100% fT ≥ minimum inhibitory concentration (MIC)** and **100% fT ≥ 4 × MIC**. - Among 142 BL-TDM events (122 patients, 129 encounters), 69% met 100% fT ≥ MIC; 41.5% met 100% fT ≥ 4 × MIC. - Median patient age was 11 years (IQR 1–17); 76.7% of hospital encounters included an ICU admission. - Cefepime and meropenem were the most frequently monitored **beta-lactams**; ampicillin and meropenem had higher rates of PK/PD target attainment. - Ampicillin achieved 88.9% for 100% fT ≥ MIC and 77.8% for 100% fT ≥ 4 × MIC; meropenem achieved 71.4% and 62.9%, respectively. - Dose adjustments were implemented in 31% of BLs, most commonly switching to continuous infusion or increasing total daily dose. - Clinical and microbiological success rates were high across the cohort and did not clearly differ by PK/PD target attainment in exploratory analyses. - Higher estimated glomerular filtration rate (eGFR) within 24 hours of TDM and younger age were independently associated with failure to achieve PK/PD targets. - Over half of patients failed to reach the more stringent 100% fT ≥ 4 × MIC target, supporting a role for BL-TDM to individualize pediatric dosing. - Details on specific clinical outcomes, definitions of success, and organism-level MIC distributions were not reported in the abstract and therefore are not included here.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Beta-Lactam Dose Optimization Using Therapeutic Drug Monitoring in Pediatric Patients [Veena Venugopalan](https://pubmed.ncbi.nlm.nih.gov/?term=Venugopalan+V&cauthor_id=42732892)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#full-view-affiliation-1 "Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#full-view-affiliation-2 "Department of Pharmacy Education and Practice, University of Florida College of Pharmacy, Gainesville, Florida."), [Kalen B Manasco](https://pubmed.ncbi.nlm.nih.gov/?term=Manasco+KB&cauthor_id=42732892)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#full-view-affiliation-1 "Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#full-view-affiliation-2 "Department of Pharmacy Education and Practice, University of Florida College of Pharmacy, Gainesville, Florida."), [Ahmad Hachem](https://pubmed.ncbi.nlm.nih.gov/?term=Hachem+A&cauthor_id=42732892)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#full-view-affiliation-3 "Department of Medicine, UF Health Shands Hospital, Jacksonville, Florida."), [Hanzhi Gao](https://pubmed.ncbi.nlm.nih.gov/?term=Gao+H&cauthor_id=42732892)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#full-view-affiliation-4 "Department of Biostatistics, University of Florida, Gainesville, Florida."), [Tao Cui](https://pubmed.ncbi.nlm.nih.gov/?term=Cui+T&cauthor_id=42732892)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#full-view-affiliation-4 "Department of Biostatistics, University of Florida, Gainesville, Florida."), [Frances M Saccoccio](https://pubmed.ncbi.nlm.nih.gov/?term=Saccoccio+FM&cauthor_id=42732892)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#full-view-affiliation-5 "Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.") Affiliations Expand ### Affiliations * 1 Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida. * 2 Department of Pharmacy Education and Practice, University of Florida College of Pharmacy, Gainesville, Florida. * 3 Department of Medicine, UF Health Shands Hospital, Jacksonville, Florida. * 4 Department of Biostatistics, University of Florida, Gainesville, Florida. * 5 Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia. * PMID: **42732892** * DOI: [ 10.1542/hpeds.2025-008993 ](https://doi.org/10.1542/hpeds.2025-008993) Item in Clipboard # Beta-Lactam Dose Optimization Using Therapeutic Drug Monitoring in Pediatric Patients Veena Venugopalan et al. Hosp Pediatr. 2026. Show details Display options Display options Format Abstract PubMed PMID Hosp Pediatr Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Hosp+Pediatr%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Hosp+Pediatr%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42732892/) . 2026 Sep 14:e2025008993. doi: 10.1542/hpeds.2025-008993. Online ahead of print. ### Authors [Veena Venugopalan](https://pubmed.ncbi.nlm.nih.gov/?term=Venugopalan+V&cauthor_id=42732892)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#short-view-affiliation-1 "Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#short-view-affiliation-2 "Department of Pharmacy Education and Practice, University of Florida College of Pharmacy, Gainesville, Florida."), [Kalen B Manasco](https://pubmed.ncbi.nlm.nih.gov/?term=Manasco+KB&cauthor_id=42732892)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#short-view-affiliation-1 "Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#short-view-affiliation-2 "Department of Pharmacy Education and Practice, University of Florida College of Pharmacy, Gainesville, Florida."), [Ahmad Hachem](https://pubmed.ncbi.nlm.nih.gov/?term=Hachem+A&cauthor_id=42732892)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#short-view-affiliation-3 "Department of Medicine, UF Health Shands Hospital, Jacksonville, Florida."), [Hanzhi Gao](https://pubmed.ncbi.nlm.nih.gov/?term=Gao+H&cauthor_id=42732892)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#short-view-affiliation-4 "Department of Biostatistics, University of Florida, Gainesville, Florida."), [Tao Cui](https://pubmed.ncbi.nlm.nih.gov/?term=Cui+T&cauthor_id=42732892)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#short-view-affiliation-4 "Department of Biostatistics, University of Florida, Gainesville, Florida."), [Frances M Saccoccio](https://pubmed.ncbi.nlm.nih.gov/?term=Saccoccio+FM&cauthor_id=42732892)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42732892/#short-view-affiliation-5 "Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.") ### Affiliations * 1 Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida. * 2 Department of Pharmacy Education and Practice, University of Florida College of Pharmacy, Gainesville, Florida. * 3 Department of Medicine, UF Health Shands Hospital, Jacksonville, Florida. * 4 Department of Biostatistics, University of Florida, Gainesville, Florida. * 5 Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia. * PMID: **42732892** * DOI: [ 10.1542/hpeds.2025-008993 ](https://doi.org/10.1542/hpeds.2025-008993) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objective:** 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. **Patients and methods:** A retrospective observational cohort study of BL-TDM was conducted from 2016 to 2023 in hospitalized patients aged 18 years 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 ≥ minimum inhibitory concentration (MIC) and 100% fT ≥ 4 × MIC. Clinical and microbiological success were evaluated as exploratory endpoints in relation to target attainment. **Results:** Among 142 BL-TDM events (122 patients, 129 hospital encounters), 69% achieved 100% fT ≥ MIC, whereas 41.5% attained 100% fT ≥ 4 × MIC. Median age was 11 years (IQR, 1-17). 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 ≥ MIC and 77.8% and 62.9% for 100%fT ≥ 4 × 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 hours of TDM and younger age were independently associated with target non-attainment. **Conclusions:** Over half of all patients failed to achieve 100%fT ≥ 4 × MIC with standard BL regimens. Furthermore, dosing adjustments made in nearly one-third of cases further emphasizes BL-TDM's role in individualizing pediatric dosing. Copyright © 2026 by the American Academy of Pediatrics. 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