Journal of Pediatric Pharmacology and Therapeutics最新文献

Objective: Celiac disease and gluten sensitivities are on the rise, with a greater prevalence of the condition in children than adults. Resources to ascertain gluten content exist but can be incomplete and focus on medications for adults. The objective of this research is to determine gluten-free status of the top 100 pediatric medications dispensed.

Methods: The top 100 pediatric medications were identified by using Optum Clinformatics Data Mart database. After list creation, manufacturers and National Drug Code (NDC) for each drug were procured and used to contact manufacturers directly for gluten content information.

Results: Evaluation of 689 NDCs was completed with 50.2% of medications documented to be gluten-free. Additional categories were confirmed gluten-free but cannot confirm cross-contamination (22.6%), cannot confirm gluten-free (25.7%), and contains gluten (1.5%). Resource tables were developed from findings though information may change, based on manufacturing ingredients and processing.

Conclusions: Pediatric medications differ in gluten content, compared with medications for adults. Incomplete information exists regarding gluten content of medications, especially pediatric resources. Development of a pediatric-specific resource for gluten content of commonly dispensed medications in children and adolescents will hopefully benefit patients with celiac disease.

In the field of epilepsy, the advent of precision medicine and the repurposing of medications for new applications have fortuitously allowed more accurate diagnosing and individually targeted therapeutics. Despite these advances, there remain patients who do not respond sufficiently-or at all-to traditionally prescribed treatments. Clinicians often need to be creative, using clinical experience and rigorous research to intuit the next step when most, if not all, anti-seizure treatments have not produced sufficient results. Herein we describe 5 medications with emerging reports of efficacy for seizure control identified by coauthor clinical experience and prescribers in clinical practice for drug information purposes (e.g., ketamine, memantine, quinidine, riluzole, trazodone). Additionally, we summarize pertinent pharmacokinetics, adverse effects, and known and potential interactions with neurologically focused medications to further guide clinical application. Ketamine and memantine appear to be promising options to apply to patients presently, while quinidine, riluzole, and trazodone have data that could contribute to future applications in specific patient populations.

Antibiotic overuse has been well-documented in all populations, including pediatrics. Pediatric pharmacists are valuable and well-integrated within inpatient antibiotic stewardship programs (ASP) in children's hospitals. The Pediatric Pharmacy Association (PPA) believes all pharmacists, regardless of practice setting, should receive education to support entry-level stewardship activities in pediatric patients. Additionally, pediatric antibiotic stewardship pharmacist leaders should ideally be trained in both infectious diseases (ID) and pediatrics. Currently, specialized training in pediatric ID lacks standardization due to the paucity of subspecialized training opportunities. This paper provides recommendations to support pediatric ASP training, education, and pharmacist staffing for inpatient programs. Further, it is recommended to ensure protected time is available for daily and longitudinal pediatric ASP activities to support optimal care and prevent burnout. Finally, the PPA supports the evolving role of the pediatric pharmacist in the ambulatory ASP arena and recommends investigations into unique payment modalities.

Eslicarbazepine acetate has been recently licensed as an anti-epileptic medication to be used in adolescents. Data regarding dosing and overdosing are still limited in the literature. We describe a rare case of intentional eslicarbazepine overdosing in a previously healthy teenager who presented with neurological toxicity. Management of hyperhydration with diuretics, haloperidol, and midazolam proved to be helpful both in inducing rapid clearance through the kidneys and in managing symptoms of agitation, respectively.

Objective: Recent literature supports the use of methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) screening to guide de-escalation of anti-MRSA antibiotics. The objective of this study was to expand on the limited pediatric data, encouraging the use of MRSA nasal PCRs as a tool to guide de-escalation of anti-MRSA antibiotics.

Methods: This single center, pre- and post-interventional, retrospective cohort study compared antibiotic regimens in pediatric patients treated empirically with anti-MRSA antibiotics, with and without MRSA nasal PCRs. Use of MRSA nasal PCRs in the pediatric hospital was encouraged following an antimicrobial stewardship provider-led continuing education presentation. The primary outcome was duration of therapy of anti-MRSA antibiotics in days. Secondary outcomes included positive predictive values (PPVs) and negative predictive values (NPVs) for all infections, pneumonia, and skin and soft tissue infections.

Results: A total of 319 patients were included in the study, 252 in the pre-intervention group and 67 in the post-intervention group. The duration of anti-MRSA antibiotic therapy in the pre-intervention group was 6.6 days compared with the post-intervention group at 2.0 days (p value = 0.027). Using data from 38 patients with concordant culture results for the infectious diagnosis, overall NPV was calculated as 92.1%. Skin and soft tissue infections and pneumonia were found to have NPVs of 90.1% (22 patients) and 100% (5 patients), respectively.

Conclusion: Implementation of MRSA nasal PCRs in pediatric patients significantly reduced the duration of anti-MRSA antibiotic therapy, promoting their utility for antimicrobial stewardship.

Objective: The purpose of this study was to characterize reported usage, dosage regimens, and monitoring practices of inhaled tobramycin in health systems with neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and cardiovascular intensive care units (CICUs) from the members of the Pediatric Pharmacy Association (PPA). The primary objective was to identify the number of respondents who use an inhaled tobramycin protocol. The secondary objectives included the main indications, dosage regimens, monitoring parameters used, and administration details for inhaled tobramycin.

Methods: A cross-sectional questionnaire was distributed to PPA members from March 28-May 22, 2023. Descriptive statistics were employed.

Results: The questionnaire was completed by respondents at 79 institutions; respondents at 61 institutions used inhaled tobramycin in PICUs (n = 45; 73.8%), NICUs (n = 36; 59.0%), and CICUs (n = 14; 23.0%). Most respondents (n = 73; 92.4%) in the 61 institutions that use inhaled tobramycin did not have an established protocol. The most common tobramycin product used was a tobramycin nebulization solution, and the most common indication was ventilator-associated tracheitis. Respondents noted the most common dosage regimen was 40 to 80 mg every 8 to 12 hours or 150 mg every 12 hours, regardless of patient age. Most respondents were unaware of the nebulizer used and the location of the nebulizer within the ventilator circuit. Additionally, the respondents noted that their intensive care units do not routinely check tobramycin serum concentrations.

Conclusion: Most respondents did not have a standardized inhaled tobramycin protocol. There are variations in the dosage regimen, administration, and monitoring practices in critically ill children receiving inhaled tobramycin. Pediatric clinical pharmacists should work with interprofessional teams, including respiratory therapists and providers, to standardize the use of inhaled antibiotics.

Objectives: The primary aim of this project was to improve the rate of prospective pharmacy verification of antibiotics in the emergency department (ED). We also aimed to streamline the process for intravenous (IV) antibiotic preparation and delivery without causing significant delays in antibiotic administration.

Methods: This retrospective evaluation compared pharmacist order verification rates for IV and oral antibiotics pre and post intervention between September 2021 and April 2022. Primary intervention involved modifications to the pharmacist verification queue and workflow prioritization. Process measures included time from order placement to pharmacy verification, pharmacy delivery, and administration. Statistical analysis of median times before and after the process change was conducted by using the Mann-Whitney U test. Control charts were used to illustrate the effect of the intervention over the defined period.

Results: During the evaluation period, a total of 2545 IV and oral antibiotic doses were ordered in the ED. The process change resulted in an increase in the number of ED IV and oral antibiotic orders verified before administration from 63% (875/1388) to 93% (1076/1157). There were substantial reductions in the pharmacy's median time to IV antibiotic order verification from 21 minutes to 7 minutes (IQR, 4-13; p < 0.05), and median time to IV antibiotic order delivery from 43 minutes to 27 minutes (IQR, 18-38; p < 0.05). Overall time to the first administrated IV antibiotic remained largely unaffected by the process change (50 vs 51 minutes; p = 0.16).

Conclusion: Implementation of mandatory pharmacy verification and preparation of IV doses in a high acuity environment like the ED is feasible without compromising antibiotic administration times.