Journal of Pediatric Pharmacology and Therapeutics最新文献

Cannabidiol (CBD) is a naturally occurring cannabinoid isolated from Cannabis sativa. CBD has therapeutic benefit for the treatment of seizures associated with various epilepsy syndromes in children; however, data are lacking related to the use of CBD for other indications in pediatric patients. Despite this lack of clinical data, the use of CBD products as a complementary treatment for various conditions in children continues to increase. Thus, it is imperative that those involved in the care of children and adolescents are well informed with current information related to CBD use in pediatrics. This review will address the pharmacology of CBD, legal and regulatory factors, usage patterns, current efficacy data, and safety concerns related to the use of CBD in children and adolescents. Recommendations for clinicians, public health officials, and researchers are also provided to effectively manage the use of unapproved CBD products in the pediatric population.

Objective: The objective of this study was to assess first through third year pediatric medical residents' confidence levels surrounding first-line pharmacotherapy for common mental health conditions in the pediatric patient population and identify areas of need in resident education initiatives.

Methods: From April 2024 through June 2024, 68 pediatric medical residents participating in a pediatric residency program at an academic tertiary medical center were invited to complete a self-assessment questionnaire. Residents rated their confidence in developing a treatment plan, prescribing, and counseling on medications for pediatric mental health conditions, general physical health conditions, and pharmacotherapy using a 5-point Likert scale.

Results: A total of 28 pediatric medical residents (41% response rate), ranging from postgraduate year 1 to year 3, completed the survey. Compared with physical health conditions, pediatric mental health conditions were associated with lower confidence scores in medical residents in the areas of developing a treatment plan (mean 3.31 vs 4.28, p < 0.001), prescribing medication (mean 2.77 vs 4.02, p<0.001), and counseling on medication side effects (mean 2.94 vs 4.01, p < 0.001).

Conclusions: This study highlights significant gaps in medical residents' confidence in managing pediatric mental health pharmacotherapy compared with physical health conditions within a single institution's residency program.

Objective: Bumetanide is commonly used to achieve diuresis and alleviate fluid overload in pediatric cardiac intensive care unit (PCICU) patients. This study aims to describe the dosing, efficacy, and safety of bumetanide continuous infusion (CI) regimens used in PCICU patients.

Methods: This single center, retrospective study included patients <6 years of age, admitted to the PCICU who received a bumetanide CI for at least 6 hours. The primary outcome was identifying doses and the total duration of bumetanide CI regimens. Secondary efficacy outcomes were determined by the ability to achieve negative fluid balance within 24 hours and the time to reach negative fluid balance. Secondary safety outcomes were based on the prevalence of electrolyte imbalances and renal impairment.

Results: Data from 90 pediatric patients represented 106 hospital encounters in this study. The median age of our study population was 137 days, with a median weight of 4.3 kg. The dose ranged from 0.005 mg/kg/hr to 0.3 mg/kg/hr, with a median dose of bumetanide of 0.046 mg/kg/hr and a median duration of 5.8 days. The change in serum electrolytes and creatinine during baseline and peak infusion rates was not clinically significant.

Conclusion: This study remains the largest pediatric study to date describing the dosing, efficacy, and safety concerns of bumetanide CI in the PCICU population. However, using a high-dose bumetanide drip >0.1 mg/kg/hr may not improve the overall outcome, and future studies can explore specific advantages of its use in neonates undergoing cardiac surgery.

Objective: To report efficacy, safety, and dosing of angiotensin II (AT-II) in pediatric patients with refractory vasodilatory shock.

Methods: This was a single center retrospective cohort study using automated, high-fidelity hemodynamic data in a large tertiary pediatric academic medical center. Pediatric patients who required multimodal vasopressor therapy for fluid refractory vasodilatory shock and received AT-II between June 2017 and November 2022 were included. High-fidelity hemodynamic data were captured via the Etiometry T3 platform. Vasoactive-inotropic score (VIS), AT-II dosing, demographics, clinical characteristics, and potential adverse effects were collected from the electronic medical record.

Results: Fourteen pediatric patients with a median age of 11.6 years (range, 13 days-16.8 years) received AT-II at a dose of 2.5 to 80 ng/kg/min for a median of 32 hours (range, 3.1-72.4). Ten of 14 patients (71%) responded favorably to AT-II therapy, experiencing a clinically significant decrease in VIS or increase in mean arterial blood pressure. The median age of responders was significantly higher than that of nonresponders (12.5 years vs 0.4 years; p = 0.002), and responders had a higher baseline VIS (56 vs 33; p = 0.008) than nonresponders. One patient (7%) experienced peripheral ischemia.

Conclusions: Angiotensin II has a potential role in the management of pediatric patients with vasodilatory shock resistant to multimodal vasopressor therapy. Demographic and clinical characteristics predicting response in the pediatric population require careful, prospective evaluation.

Objective: The University of Oklahoma College of Pharmacy created the Pediatric Degree Option Program (PDOP) to enhance the knowledge and skills of students in pediatric pharmacy. The purpose of the study was to identify the pediatric-focused research and scholarship activities and outcomes of PDOP graduates.

Methods: This was a retrospective study of PDOP graduates from 2011-2022. The primary objective was to identify the overall number of activities conducted during the PDOP. Secondary objectives included the overall number of peer-reviewed and non-peer reviewed publications, and comparison of the median number of scholarship activities per PDOP graduate between those who did and did not complete a PGY1 residency. Inferential statistics were performed using Mann-Whitney U and Chi-square or Fischer's exact test as appropriate, with an a priori p value <0.05.

Results: Fifty-two PDOP graduates completed the program. Following graduation, 23 (44.2%) individuals completed a postgraduate year-one (PGY1) residency. PDOP graduates completed a total of 53 research and scholarship activities. The majority (n=44; 83.0%) were original research projects, and 41 (77.4%) graduates published ≥1 manuscript. There was a significant difference in manuscript authorship between graduates who did and did not complete a residency (18 versus 7, p<0.001). Seventeen (26.2%) of the PDOP scholarship projects involved collaboration with a PGY1/postgraduate year-two (PGY2) resident.

Conclusions: This study demonstrated that students enrolled in a curricular track were exposed to various aspects of the research and scholarship process. Many of the activities resulted in a publication or presentation for the PDOP graduate.

Staphylococcus aureus infection is one of the most common and serious infections that arises in children and is associated with high morbidity. S. aureus is the leading cause of acute hematogenous osteomyelitis in children. In the absence of concerns regarding resistance to methicillin, an anti-staphylococcal isoxazolyl penicillin, such as oxacillin or nafcillin, is the drug of choice for treatment of S. aureus osteomyelitis. However, first-generation cephalosporins, such as cefazolin, can also be used. There are limited antimicrobial options available for osteomyelitis and persistent or intermittent bacteremia when surgical intervention for source control is not indicated or feasible. Hence, there is a need to improve our knowledge of synergistic antimicrobial combinations to guide clinical practice and improve outcomes, particularly among children. We present the case of an 11-year-old child with persistence of acute hematogenous vertebral osteomyelitis with discitis and bacteremia, despite appropriate treatment with an anti-staphylococcal beta-lactam. Blood cultures were sterilized, and symptoms resolved after the addition of ertapenem 1 g daily for 7 days. To our knowledge, this is the first report of using ertapenem in combination with an anti-staphylococcal beta-lactam to specifically treat persistent methicillin-susceptible S. aureus (MSSA) vertebral osteomyelitis with bacteremia. Similar success has been reported using this combination to treat adults with persistent MSSA bacteremia and preterm low-birth-weight infants with late-onset neonatal sepsis; hence, our report provides further support for the benefit of this combination in staphylococcal infections.

Objective: Monoclonal antibody therapy has been used to treat COVID-19, with paucity of literature about its use in children. This retrospective study sought to evaluate the effectiveness of preventing hospitalization and safety of monoclonal antibody (mAb) treatment (bamlanivimab-etesevimab and casirivimab-imdevimab) for COVID-19 in patients ≤18 years of age.

Methods: Between January 1 and December 31, 2021, patients were selected for mAb therapy, based on the referring provider's clinical assessment of high risk for progression to severe COVID-19. The choice of mAb was determined by drug availability, compounding feasibility, and documented in vitro activity against circulating SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) variants. All patients received a single-dose infusion. Primary outcomes included hospital readmissions and emergency department (ED) visits within 90 days of treatment. The secondary outcome was safety/adverse events.

Results: Of 141 patients who received mAbs in 2021, only 3 experienced ongoing COVID-19 symptoms. Only 1 patient necessitated escalated care owing to persistent COVID-19 symptoms post infusion. There were no infusion-related side effects or hospitalizations in the 90 days post infusion.

Conclusion: Monoclonal antibodies appear to be safe and effective in preventing hospitalizations in COVID-19-positive children.

Pharmacy students, residents, and new practitioners may feel overwhelmed with patients in the pediatric critical care setting due to the disease states, variation in acuity based on patient factors, and complex medication regimens. The FASTHUG MAIDENS mnemonic is a standardized and validated tool that was developed in 2011 for pharmacists to use when evaluating critically ill adult patients. However, there are no studies evaluating the use of this tool in pediatric critical care setting. This article aims to provide trainees and new practitioners with a new and distinct mnemonic tool, IN-DEPTH, to use when evaluating critically ill pediatric patients and identifying areas for treatment optimization. In addition, this article will provide rationale and examples to enhance the user's understanding of the components and subcomponents of the mnemonic. Ultimately, the goal of the IN-DEPTH mnemonic is to help provide some structure for pharmacy trainees or new practitioners that are less experienced with critical or pediatric care and provide the opportunity to have a meaningful impact in the care of critically ill pediatric patients.

Continuous kidney replacement therapy (CKRT) can influence pharmacokinetics (PK), including clearance (CL) of antibiotics like piperacillin (PIP). Both CKRT intensity, or "dialysis dose," and residual kidney function can alter PIP PK and pharmacodynamic (PD) target attainment (TA), defined by the percentage of time free PIP concentrations exceed the minimum inhibitory concentration (% fT > MIC). In existing reports, children receiving PIP and CKRT are usually oligoanuric, so PIP PK/PD in non-oligoanuric patients receiving high-intensity CKRT is unknown. This report analyzes free PIP PK/PD in a child with robust kidney function who received 30-minute infusions of 100 mg/kg PIP-tazobactam every 6 hours while on high-intensity CKRT after liver-kidney transplant for primary hyperoxaluria. Model-informed PK software was used to estimate PK/PD parameters for periods on and off CKRT. PIP CL on CKRT was 66% higher than off CKRT (5.59 L/hr vs 3.36 L/hr). Nearly 100% fT > 1xMIC (using 8 mg/L for Enterobacterales) was achieved whether on or off CKRT, but only 60% fT > 4xMIC was achieved on CKRT. CKRT CL was 40% of total CL on CKRT and 51% of the CKRT dialysis dose, suggesting PIP elimination was mostly renal despite high-intensity dialysis. Monitoring of free PIP concentrations may help ensure proper TA in non-oligoanuric patients receiving high-dose CKRT.