Antimicrobials
Improving access to effective antimicrobial treatment for children.
The challenge
Antimicrobials are the most frequently prescribed medications in children.
The Antimicrobials Research group is focused on addressing the clear inequity in access to effective antimicrobial treatment for children compared with adults.
This disparity leads to poorer clinical outcomes, including higher rates of illness (morbidity) and death (mortality) from infection. Inadequate or inappropriate treatment also contributes to the global rise of antimicrobial resistance.
Our research focus
Our research aims to facilitate interdisciplinary collaborations to close these gaps by improving the safety, effectiveness and accessibility of antimicrobial therapies for children.
- Conduct rigorous clinical trials in children: We design and deliver high‑quality clinical trials to generate evidence on the safety and effectiveness of antimicrobial treatments specifically for paediatric populations.
- Optimise treatment using pharmacometrics: Through advanced pharmacometric modelling, we improve dosing accuracy, reduce toxicity and ensure children receive the most effective antimicrobial therapy.
- Personalise medication using genomics and digital health: We apply genomic technologies and digital health tools to tailor antimicrobial treatment to each child, improving outcomes and reducing unnecessary exposure.
- Strengthen understanding of off‑label medication use: We collect and analyse data on off‑label antimicrobial prescribing in children to inform safer, evidence‑based treatment guidelines for future care.
Group Leaders
Group Members
Our projects
BEST Trial
The BEST Trial aims to determine whether treatment of bone and joint infections in children with oral antibiotics alone is just as effective as treatment with intravenous antibiotics followed by an oral antibiotic course.
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EARSHOT Study
EARSHOT Study is an international, multicentre prospective cohort study evaluating the risk of hearing loss in children receiving antibiotic treatment.
We are improving paediatric care by predicting and preventing aminoglycoside antibiotic associated hearing damage.
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ID MAGIC Trial
The ID MAGIC Trial aims to find a better way of treating children with cytomegalovirus (CMV) infection, by seeing if giving ganciclovir as a personalised dose using a web-based dosing app is better than the current method based only on the child’s weight.
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Preventing permanent hearing loss from antibiotic treatment using point-of-care genomic testing
Developing a bedside genomic test for safer, paediatric antibiotic use.
Our project aims to evaluate the role of genetic testing to prevent permanent drug-related hearing loss in children receiving aminoglycoside antibiotic treatment with a view to developing a rapid bedside, point-of-care test that can be used routinely prior to treatment.
Read more...ITCHY- Ivermectin Therapy in CHildren under 5 Years of age
A multicentre, open-label prospective pharmacokinetic study in Laos PDR aims to determine in young children under five years old if the standard 3mg ivermectin dose or age-based dose achieves comparable drug exposure to the recommended dose in older children.
We will also determine whether this dose is safe and effective for the treatment of scabies infection in this age group.
SNAP – Staphylococcus aureus Network Adaptive Platform trial (SNAP)
A multicentre, open-label randomised adaptive trial that aims to identify the effect of a range of clinical interventions on all-cause 90-day mortality in patients with Staphylococcus aureus bloodstream infection (SAB).
FosUTI – FOSfomycin Versus Standard of Care in Children with Antibiotic-Resistant Urinary Tract Infections
A multi-centre non-inferiority, pragmatic, adaptive trial to evaluate the safety, tolerability, efficacy and pharmacokinetics of oral fosfomycin in children with antibiotic-resistant urinary tract infections.
Pharmacokinetic (PK) and Pharmacodynamic (PD) audit and observational studies
O-SNAP – Optimising antibiotic dosing in the Staphylococcus aureus Network Adaptive Platform trial
A multi-centre pharmacokinetic-pharmacodynamic (PKPD) sub-study embedded in the SNAP trial aims to compare the difference in treatment success at day 90, between patients receiving treatment with a β-lactam antibiotic for methicillin-sensitive S. aureus bacteraemia who have achieved a conventional PKPD target, versus those that have not achieved the PKPD target.
Optimising antibiotic dosing children with bacteremia
A prospective observational study that aims to determine the pharmacodynamic target of commonly used antibiotics in children with bacteraemia due to Staphylococcus aureus, Streptococcus pneumoniae, E. coli, Group A Streptococcus or Pseudomonas aeruginosa.
Determining antimicrobial pharmacokinetics and pharmacodynamics in young infants
A prospective observational study that aims to determine the pharmacokinetics and pharmacodynamics of antimicrobials in young infants aged zero to 120 days admitted to the neonatal intensive care unit at The Royal Children's Hospital.
Advancing the evidence base for off-label medications in children
A multicentre prospective audit that aims to determine dosing regimens used as well as the safety and efficacy of off-label medications in children up to 18 years of age admitted to the participating paediatric hospitals. This study will also determine the population PK of off-label medications used in children aged up to 18 years.
ATOMIC – Alternative therapeutic drug monitoring and dose optimisation in immunosuppressed paediatric patients
A prospective observational cohort study that aims to determine in paediatric oncology and bone marrow transplant patients the pharmacokinetics of antifungals and immunosuppressants.
Pharmacokinetics and Pharmacodynamics of priority paediatric antibiotics
Single site prospective observation pharmacokinetic and pharmacodynamic study to determine dosing regimens used as well as the safety and efficacy of amoxicillin-clavulanic acid, azithromycin, cefiderocol and nitrofurantoin in children.
A pharmacokinetic study of fluoroquinolones using capillary microsampling
A single-site, prospective study at The Royal Children’s Hospital (RCH) will investigate the pharmacokinetics of ciprofloxacin, levofloxacin, and moxifloxacin in children up to 18 years and validating capillary microsampling for measuring fluoroquinolone concentrations.
VANC APP – Assessing Precise dosing and Prompt drug monitoring to improve the attainment of target concentrations
A multisite prospective cohort study to determine the proportion of young infants achieving target trough vancomycin concentrations at the first steady-state level when using a model-based dosing regimen and the proportion of those when model-based dosing issued followed by therapeutic drug monitoring (TDM)and dose adjustment after the first dose.
DOSE CF Kids – opportunistic pharmacokinetic-pharmacodynamic sub-study of the BEAT CF Pulmonary Exacerbations Cohort
Prospective PKPD study nested in the BEAT CF (Bayesian Evidence Adaptive Treatment of Cystic Fibrosis) trial which aims to characterise the PKPD of intravenous antibiotics used for the treatment of pulmonary exacerbations in children with cystic fibrosis. This will inform optimal antibiotic dosing.
Research studies on adverse drug reactions
A Stratified Automated Allergy Assessment Risk Tool (SMAART) embedded in the electronic medical record to de-label children with antibiotic allergies
A multicentre prospective audit of a clinical decision support intervention – an automated tool built in the hospital Electronic Medical Record (EMR) – to improve the risk stratification, assessment, and de-labelling of children with an antibiotic allergy label.
Network projects
Australasian Kids Dose Consortium
A network of paediatric clinician researchers from tertiary hospitals across Australia and New Zealand was established to serve as a dedicated platform for the research of therapeutics for the most common diseases of childhood. This consortium will bolster the capacity and capability to rapidly implement paediatric trials of therapeutics in the face of emerging health threats.
Funding
Thank you to our supporters.
- National Health and Medical Research Council (NHMRC)
- Medical Research Future Fund (MRFF)
- Thrasher Research Fund
- HCF Research Foundation
- Australasian Society of Infectious Diseases
- Avant Foundation Doctor in Training Research Scholarship
Collaborations
We partner with leading institutions worldwide, including:
- Australasian Kids Dose Consortium
- Burnet Institute
- Certara
- Christchurch Hospital, New Zealand
- Fudan University, China
- Great Ormond Street Institute of Child Health, United Kingdom
- John Hunter Hospital
- Australasian Kids Dose Consortium
- Kidzfirst at Middlemore, New Zealand
- Lao Tropical and Public Health Institute
- Menzies School of Health Research
- Monash Children’s Hospital
- Monash University
- Pathology Queensland
- Perth Children’s Hospital
- The Royal Children’s Hospital
- Royal Darwin Hospital
- Royal Hobart Hospital
- Shenzhen Children’s Hospital, China
- South Australian Health and Medical Research Institute
- Starship Children’s Hospital, New Zealand
- Sydney Children’s Hospital, Randwick
- Sydney School of Public Health
- The Children’s Hospital at Westmead
- The Peter Doherty Institute For Infection and Immunity
- Telethon Kids Institute
- University of Auckland
- University of Melbourne
- University of Newcastle
- University of Otago
- University of Sydney
- University of Queensland
- Victorian Infectious Diseases Service
- Queensland Children’s Hospital
- Women’s and Children’s Hospital
Key publications
Gwee A, Cranswick N, McMullan B, et al. Continuous Versus Intermittent Vancomycin Infusions in Infants: A Randomized Controlled trial. PEDIATRICS. 2019;143(2):e20182179. DOI:10.1542/peds.2018-2179
Gwee A, Steer A, Phongluxa K, Luangphaxay C, Senggnam K, Philavanh A, Lei A, Martinez A, Huang S, McWhinney B, Ungerer J, Duffull S, Yang W, Zhu X, Coghlan B. Ivermectin therapy for young children with scabies infection: a multicentre phase 2 non-randomized trial. Lancet Reg Health West Pac. 2024 Jul 13;49:101144. doi: 10.1016/j.lanwpc.2024.101144. PMID: 39109221; PMCID: PMC11301252.
Gwee A, Duffull S, Zhu X, Tong SYC, Cranswick N, McWhinney B, Ungerer J, Francis J, Steer AC. Population pharmacokinetics of ivermectin for the treatment of scabies in Indigenous Australian children. PLoS Negl Trop Dis. 2020 Dec 7;14(12):e0008886. DOI:10.1371/journal.pntd.0008886
Wilkins AL, Lai T, Zhu X, Bolisetty S, Chiletti R, Cranswick N, Gardiner K, Hunt R, Malhotra A, McMullan B, Mehta B, Michalowski J, Popat H, Ward M, Duffull S, Curtis N, Gwee A. Individualized vancomycin dosing in infants: prospective evaluation of an online dose calculator. Int J Antimicrob Agents. 2023 Mar;61(3):106728. doi: 10.1016/j.ijantimicag.2023.106728. Epub 2023 Jan 16. PMID: 36657532.
Gwee A, Autmizguine J, Curtis N, Duffull SB. Twice- and Thrice-daily Cephalexin Dosing for Staphylococcus aureus Infections in Children. Pediatr Infect Dis J. 2020 Jun;39(6):519-522. DOI:10.1097/INF.0000000000002646
Grinlington L, Choo S, Cranswick N, Gwee A. Non-β-Lactam Antibiotic Hypersensitivity Reactions. Pediatrics. 2020 Jan;145(1):e20192256. doi: 10.1542/peds.2019-2256. Epub 2019 Dec 3. PMID: 31796504.
Catalano AC, Pittet LF, Choo S, Segal A, Stephens D, Cranswick NE, Gwee A. Impact of antibiotic allergy labels on patient outcomes in a tertiary paediatric hospital. Br J Clin Pharmacol. 2022 Mar;88(3):1107-1114. doi: 10.1111/bcp.15038. Epub 2021 Sep 9. PMID: 34388858.
Sosnin N, Curtis N, Cranswick N, Chiletti R, Gwee A. Vancomycin is commonly under-dosed in critically ill children and neonates. Br J Clin Pharmacol. 2019 Nov;85(11):2591-2598. doi: 10.1111/bcp.14084. Epub 2019 Aug 30. PMID: 31378957; PMCID: PMC6848905.
Wilkins AL, Steer AC, Cranswick N, Gwee A. Question 1: Is it safe to use ivermectin in children less than five years of age and weighing less than 15 kg? Arch Dis Child. 2018 May;103(5):514-519. doi: 10.1136/archdischild-2017-314505. Epub 2018 Feb 20. PMID: 29463522.
Pittet LF, Messina NL, Orsini F, Moore CL, Abruzzo V, Barry S, Bonnici R, Bonten M, Campbell J, Croda J, Dalcolmo M, Gardiner K, Gell G, Germano S, Gomes-Silva A, Goodall C, Gwee A, Jamieson T, Jardim B, Kollmann TR, Lacerda MVG, Lee KJ, Lucas M, Lynn DJ, Manning L, Marshall HS, McDonald E, Munns CF, Nicholson S, O'Connell A, de Oliveira RD, Perlen S, Perrett KP, Prat-Aymerich C, Richmond PC, Rodriguez-Baño J, Dos Santos G, da Silva PV, Teo JW, Villanueva P, Warris A, Wood NJ, Davidson A, Curtis N; BRACE Trial Consortium Group. Randomized Trial of BCG Vaccine to Protect against Covid-19 in Health Care Workers. N Engl J Med. 2023 Apr 27;388(17):1582-1596. doi: 10.1056/NEJMoa2212616. PMID: 37099341; PMCID: PMC10497190.