Journal of Pediatric Pharmacology and Therapeutics最新文献

Objective: This study assessed the relationship between antibiotic durations and the use of procalcitonin (PCT) in febrile pediatric patients with sickle cell disease (SCD), including those diagnosed with acute chest syndrome (ACS) and/or vaso-occlusive crisis (VOC).

Methods: This multicenter, retrospective cohort study compared antibiotic durations in febrile pediatric SCD patients between 2 cohorts, 1 utilizing PCT (PCT cohort) and 1 not utilizing PCT (no-PCT cohort). Secondary endpoints compared the impact of PCT on antibiotic durations in those also diagnosed with ACS and/or VOC.

Results: A total of 258 patient encounters were included. The overall mean antibiotic duration in the PCT cohort was 4.2 days (SD 2.6) vs 4.7 days (SD 3.6) (p = 0.991). For those diagnosed with ACS (n = 17), the mean antibiotic duration was 6 days (SD 2.2) in the PCT cohort vs 9.7 days (SD 3.5) (p = 0.037; n = 7). Those diagnosed with both VOC and ACS (n = 40) averaged 5.6 days (SD 1.9) in the PCT cohort vs 9.3 days (SD 3.2) (p = 0.002; n = 9). Regression analyses revealed an increased odds of longer antibiotic duration in the no-PCT cohort for those with ACS (OR 1.51, 95% CI 1.07-2.13, p = 0.019), and for those with both VOC and ACS (OR 1.72, 95% CI 1.22-2.42, p = 0.002).

Conclusions: There was not a significant difference in overall antibiotic durations between cohorts. However, in the PCT cohort there was a significant reduction of antibiotic durations seen in patients diagnosed with ACS or VOC and ACS, averaging 3.7 fewer days of antibiotics.

Drug induced neutropenia is an uncommon but potentially serious side effect in children receiving prolonged β-lactam antibiotic therapy. Management of β-lactam induced neutropenia in children remains challenging and often requires antibiotic therapy interruption or modification. There are limited data in pediatric patients about use of granulocyte-colony stimulating factor (G-CSF) for the treatment of drug induced neutropenia. We report the use of G-CSF for β-lactam induced neutropenia in four pediatric patients between the ages of 3 months and 18 years with bacterial meningitis in this case series.

Sepsis is one of the primary causes of newborn morbidity and mortality, particularly in preterm infants, and coagulase-negative staphylococci (CoNS) is a major cause of bacterial infections in the neonatal intensive care unit (NICU). The treatment of late-onset neonatal staphylococcal sepsis is challenging owing to increased minimum inhibitory concentrations and the potential side effects of vancomycin. Herein, we describe 2 cases of extremely preterm newborns treated with intravenous (IV) ceftaroline (6 mg/kg/dose every 8 hours) for late-onset neonatal staphylococcal sepsis. Both cases were diagnosed with bacteremia and treated with ceftaroline. However, one of the patients died, most likely from sepsis or other factors, including chronic lung illness and prematurity, despite sterile blood cultures after starting the ceftaroline treatment. Large-scale randomized studies are required to examine the optimal dosing, safety, and effectiveness of IV ceftaroline for sepsis caused by CoNS in neonates.

Mitogen-activated extracellular kinase inhibitors, including trametinib and selumetinib, are increasingly used to treat pediatric low-grade gliomas. Trametinib, while administered orally and with minimal myelosuppression, is reported to cause rash, diarrhea, and fatigue. Selumetinib has been associated with skin irritation, diarrhea, and musculoskeletal pain. This case report describes an 8-month-old male with a low-grade glioma (LGG) that progressed 6 months post-chemotherapy and was started on trametinib due to its liquid formulation and minimal side effect profile. However, the patient developed severe diarrhea, abdominal pain, neck pain, rigidity, and decreased stamina. These symptoms necessitated discontinuation of trametinib, after which all symptoms resolved within a week. This case highlights the first reported instance of trametinib-induced myalgia and rigidity in a pediatric patient receiving trametinib therapy for a LGG. Clinicians should consider these rare but significant adverse effects when choosing an antineoplastic therapy for the treatment of progressive LGG.

Cannabis is a highly discussed topic in medicine today. From therapeutic applications in conditions such as chronic pain, multiple sclerosis, epilepsy, chemotherapy-induced nausea and vomiting, and inflammatory bowel disease to the growing prevalence of recreational use, cannabis remains at the forefront of medical and societal conversations. In this review, we will explore the history of marijuana use in medicine, examine the current evidence supporting its pharmacological benefits, and delve into its impact on the developing brain. Additionally, we will highlight the pivotal role pharmacists play in this evolving landscape and guide you through the latest research findings.

Objective: Variations in pharmacokinetics necessitate monitoring anti-Xa concentrations for optimal anticoagulation in pediatric patients receiving enoxaparin for the prophylaxis or treatment of venous thromboembolism. Pharmacists play an essential role through pharmacist-to-dose (PTD) protocols. This study aims to assess the impact of pharmacist involvement by comparing rates of achieving target anti-Xa concentrations before and after implementation of the PTD protocol in a pediatric population.

Methods: Medical records were queried for patients 18 years old and younger who received enoxaparin as an inpatient at West Virginia University Medicine Children's Hospital from January 2016 to September 2023. Indication, dosing, and administration of enoxaparin were assessed. Anti-Xa concentrations were evaluated for appropriate timing and goal range. Secondary outcomes included the number of anti-Xa concentrations drawn, the number of enoxaparin dose adjustments, the rate of accurately drawn anti-Xa concentrations, the rate of following guideline recommended enoxaparin dosing on initiation, and the time to goal anti-Xa concentration.

Results: There was no difference in the rate of anti-Xa concentrations that were in goal before and after the implementation of a pharmacist-led enoxaparin dosing protocol. The frequency of concentrations drawn appropriately was higher, and the time to goal was shorter after the implementation of the PTD protocol, although this difference was not statistically significant.

Conclusions: There was no difference in the rate of anti-Xa concentrations that were in goal between groups. This likely stemmed from the use of the same dose adjustment guideline among both groups. This underscores the equal quality of care provided by pharmacists in achieving optimal anticoagulation and positive outcomes.

Objective: The purpose of this survey was to evaluate knowledge and perception of naloxone among patients with sickle cell disease and their caregivers.

Methods: A 13-question survey about naloxone and the subject's perception of naloxone was developed by the research team and reviewed by 5 advocates for pediatric patients with sickle cell disease. The survey was offered to patient-caregivers and patients ≥12 years old with sickle cell disease and a prescription for home opioid medication. The survey was conducted during a clinic visit or inpatient admission with a convenience sampling strategy.

Results: A total of 23 surveys were completed (9 patients and 14 caregivers). Nine of 23 subjects (40%) said they had heard of naloxone. Three subjects had naloxone at home. Only 3 caregivers said having naloxone at home would change their opioid use behavior.

Conclusion: There is a lack of awareness about naloxone in the pediatric sickle cell disease population. Those who were aware of naloxone did feel it was an important medication and appeared to have a positive view of it.

Objective: This study aimed to investigate the chemical stability of diphenhydramine in a pediatric "Magic Mouthwash" preparation, specifically a 1:1 mixture of aluminum hydroxide/magnesium hydroxide/simethicone (Mylanta comparable product) and liquid diphenhydramine over 90 days under different storage conditions.

Methods: A high-performance liquid chromatography-ultraviolet method was developed for quantifying diphenhydramine in the mouthwash. A total of 10 bottles of mouthwash were prepared, with half stored in the refrigerator and half kept at room temperature. The method was applied to analyze the stability of diphenhydramine in the mouthwash preparations, with 5-mL aliquots removed from each bottle at 0, 1, 7, 14, 30, 60, and 90 days. Stability was defined as maintaining 90-110% of the initial concentration.

Results: Both storage conditions (room temperature: 19.3 ± 0.8°C; refrigeration: 3.01 ± 0.3°C) maintained stable temperatures. The pH remained stable (room temperature: 8.34 ± 0.4; refrigeration: 8.38 ± 0.4). Diphenhydramine concentrations stayed within the 90-110% range for the entire study duration under both conditions. No statistically significant differences in diphenhydramine concentration were observed between storage conditions or over time.

Conclusion: The pediatric "Magic Mouthwash" demonstrated stable pH and diphenhydramine potency over 90 days, regardless of whether it was stored at room temperature or refrigerated. This supports the feasibility of bulk preparation and extended storage of this formulation, providing a safe and effective alternative to lidocaine-containing mouthwash for pediatric patients.