Journal of Pediatric Pharmacology and Therapeutics最新文献

Objective: Nigella sativa (NS) has been widely used and investigated in several pediatric studies; however, its safety and efficacy in pediatrics are yet to be evaluated. This systematic review evaluates the clinical uses, safety, and efficacy of NS in pediatrics.

Methods: The search was conducted across 4 databases, including PubMed, Web of Science, Scopus, and Cochrane, up to September 6, 2023, and included clinical trials using NS in pediatrics. A methodological quality assessment was performed using the Cochrane risk of bias tool for randomized trials (Rob 2). A meta-analysis was conducted to evaluate safety. The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Two hundred sixty-five studies were screened for eligibility, including 125 papers from Scopus, 31 from PubMed, 37 from Cochrane, and 72 from the Web of Science. Sixty-eight duplicate papers were eliminated, and 185 studies were excluded. Three studies were added from snowballing. Fifteen clinical trial studies were included in this review. Limited studies have been conducted on NS in pediatrics. Based on the meta-analysis, no statistically significant side effects have occurred. Different doses and forms of NS were used, and most studies have reported improvements in the outcomes.

Conclusion: More high-quality studies are needed to establish the efficacy of using NS in different diseases, along with its effective dose and form. The studies in this review report no severe adverse effects and no statistically significant occurrence of side effects. However, further studies are needed to fully understand the safety of using NS in pediatrics.

Objective: People with cystic fibrosis (pwCF) have impaired bacterial mucociliary clearance, which can result in colonization with pathogens like Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) in the lower airway. Although guidelines for the eradication of P. aeruginosa in CF are well-established, MRSA eradication guidelines are lacking. This study aimed to determine the rates of MRSA eradication in pwCF based on a prescribed antibiotic regimen.

Methods: This retrospective chart review included pwCF with a first lifetime positive MRSA respiratory culture or first positive MRSA respiratory culture after at least 1 year of MRSA negativity (minimum of 4 negative respiratory cultures) obtained at Nationwide Children's Hospital between August 1, 2012, and February 28, 2022. Secondary outcomes assessed the impact of adding topical decontamination on MRSA eradication and the time to a subsequent MRSA-positive respiratory culture after completing the eradication regimen.

Results: Sixty-two patients were included, and 16% achieved MRSA eradication. Intravenous vancomycin transitioned to oral trimethoprim-sulfamethoxazole achieved the highest eradication rate of 75% (p = 0.008). Antibiotics consisting of dual therapy with rifampin and topical decontamination had a higher rate of eradication (25%) compared with antibiotics alone, antibiotics with topical decontamination, or no antibiotics. Four patients had no subsequent MRSA-positive cultures, including 2 patients who did not receive antibiotics.

Conclusions: The transition from intravenous vancomycin to oral trimethoprim-sulfamethoxazole had the highest rate of MRSA eradication. Overall rates of MRSA eradication at 12 months in patients CF using antibiotics with or without topical decontamination are low.

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.