Managing Patient Pressure to Prescribe Antibiotics in the Clinic
AbstractAcute respiratory tract infections (ARTIs) are typically viral; however, in the USA, approximately one-third of adults and 52% of children with ARTIs receive an antibiotic, making antibiotic prescribing for ARTIs a major contributor to the problem of inappropriate prescribing. Relying on a synthesis of work across pediatric and adult primary care, this article shows some of the main ways that patients and parents pressure physicians for antibiotics, whether intentionally or unintentionally, and how physicians combat that pressure. All data are from video recordings of community-based clinical encounters allow ing...
Source: Pediatric Drugs - August 19, 2021 Category: Pediatrics Source Type: research
Management of IgA Vasculitis with Nephritis
AbstractImmunoglobulin A (IgA) vasculitis (IgAV), previously called Henoch –Schönlein purpura, is characterized by IgA-dominant immune deposits affecting small vessels and often involves the skin, gastrointestinal tract, joints, and kidneys. IgAV is the most common cause of systemic vasculitis in children. The long-term prognosis is dependent on renal involvement: IgAV with nephritis (IgAVN) can progress to renal failure. IgAVN is an inflammatory disease, providing a rationale for the use of corticosteroids. However, data supporting the use of corticosteroids in patients with established IgAVN of any severity remain lim...
Source: Pediatric Drugs - August 16, 2021 Category: Pediatrics Source Type: research
Asparaginase-Associated Pancreatitis in Pediatric Patients with Acute Lymphoblastic Leukemia: Current Perspectives
AbstractAsparaginase therapy is a vital agent in the treatment of acute lymphoblastic leukemia (ALL), with increasing evidence of its high importance in high-risk ALL populations. However, despite the clear clinical and biological benefits of asparaginase therapy, many patients experience toxicities. A well-known treatment-limiting toxicity is asparaginase-associated pancreatitis (AAP). If severe, it necessitates discontinuation of asparaginase therapy, which can lead to a higher risk of relapse in patients with ALL. New protocols for ALL therapy have increased overall total doses of asparaginase therapy in select high-ris...
Source: Pediatric Drugs - August 5, 2021 Category: Pediatrics Source Type: research
Pediatric Urologic Surgery: Reducing Opioid Use
AbstractAdequate pain management is important for successful postoperative recovery after any surgical procedure. Unfortunately, the USA and many other parts of the world are in the midst of an opioid epidemic, and healthcare providers are thus tasked with balancing the comfort and recovery of their patients after an operation against the individual and societal harms of the over-prescription of opioids. The goal of this article is to discuss the range of opioid formulations currently in use, examine why this may be problematic, and explore alternatives that provide similar efficacy and may improve overall safety in the pe...
Source: Pediatric Drugs - July 31, 2021 Category: Pediatrics Source Type: research
Pharmacokinetics of Ceftazidime in Children and Adolescents with Obesity
ConclusionOur analysis suggests administration of 40 mg/kg IV q6h (max 8 g/day) maximizes PTA in children and adolescents with obesity and GFR ≥ 80 mL/min/1.73 m2.Trial RegistrationClinicaltrials.gov Identifier: NCT01431326. (Source: Pediatric Drugs)
Source: Pediatric Drugs - July 23, 2021 Category: Pediatrics Source Type: research
Secondary Dysgammaglobulinemia in Children with Hematological Malignancies Treated with Targeted Therapies
AbstractTargeted therapies have emerged as innovative treatments for patients whose disease does not respond to conventional chemotherapy, and their use has widely expanded in the field of pediatric hematologic malignancies in the last decade. While they carry the promise of improved disease control and survival and are currently investigated in first-line treatment protocols for patients with poor prognostic markers, they are associated with a considerable incidence of specific toxicities, including cytokine-release syndrome, neurotoxicity, hepatotoxicity, nephrotoxicity, cardiotoxicity, endocrine adverse events, and infe...
Source: Pediatric Drugs - July 22, 2021 Category: Pediatrics Source Type: research
An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus
AbstractChildhood-onset systemic lupus erythematosus (cSLE) is a prototype of a multisystemic, inflammatory, heterogeneous autoimmune condition. This disease is characterized by simultaneous or sequential organ and system involvement, with unpredictable flare and high levels of morbidity and mortality. Racial/ethnic background, socioeconomic status, cost of medications, difficulty accessing health care, and poor adherence seem to impact lupus outcomes and treatment response. In this article, the management of cSLE patients is updated. Regarding pathogenesis, a number of potential targets for drugs have been studied. Howeve...
Source: Pediatric Drugs - July 10, 2021 Category: Pediatrics Source Type: research
Evaluating and Mitigating Risk of Acute Kidney Injury with the Combination of Vancomycin and Piperacillin-Tazobactam in Children
AbstractThe antibiotic combination of vancomycin (VAN) and piperacillin-tazobactam (PTZ) has been associated with an increased risk of acute kidney injury (AKI) in both adult and pediatric patients. In this review, we highlight some of the limitations of existing pediatric studies evaluating the combination of VAN/PTZ, focusing on AKI risk in specific pediatric patient populations. We also review the variability in defining AKI in children and provide guidance to clinicians for use of prospective surveillance and stewardship in mitigating the risk of AKI in pediatric patients treated with combination of VAN/PTZ. Based on r...
Source: Pediatric Drugs - July 7, 2021 Category: Pediatrics Source Type: research
Navigating the Regulatory Landscape to Develop Pediatric Oncology Drugs: Expert Opinion Recommendations
AbstractRegulatory changes have been enacted in the United States (US) and European Union (EU) to encourage the development of new treatments for pediatric cancer. Here, we review some of the factors that have hampered the development of pediatric cancer treatments and provide a comparison of the US and EU regulations implemented to address this clinical need. We then provide some recommendations for each stage of the oncology drug development pathway to help researchers maximize their chance of successful drug development while complying with regulations. A key recommendation is the engagement of key stakeholders such as ...
Source: Pediatric Drugs - June 26, 2021 Category: Pediatrics Source Type: research
Assessment of the Effects of a High Amikacin Dose on Plasma Peak Concentration in Critically Ill Children
ConclusionsDespite the administration of the maximal recommended amikacin dose,Cmax was below the pharmacokinetic target in 70% of our pediatric population. Further studies are needed to develop a pharmacokinetic model in a population of critically ill children to optimize target attainment. (Source: Pediatric Drugs)
Source: Pediatric Drugs - June 18, 2021 Category: Pediatrics Source Type: research
Mirabegron: Pediatric First Approval
This article summarizes the milestones in the development of mirabegron for NDO leading to this pediatric first approval. (Source: Pediatric Drugs)
Source: Pediatric Drugs - May 31, 2021 Category: Pediatrics Source Type: research
Pain Management in Children: NSAID Use in the Perioperative and Emergency Department Settings
AbstractNonsteroidal anti-inflammatory drugs (NSAIDs) are often used for pediatric pain management in the emergency setting and postoperatively. This narrative literature review evaluates pain relief, opioid requirements, and adverse effects associated with NSAID use. A PubMed search was conducted to identify randomized controlled trials evaluating the use of conventional systemic NSAIDs as pain management for children in the perioperative or emergency department (traumatic injury) setting. Trials of cyclooxygenase-2 inhibitors ( “coxibs”) were excluded. Search results included studies of ibuprofen (n = 12), ketoprof...
Source: Pediatric Drugs - May 28, 2021 Category: Pediatrics Source Type: research
Lidocaine Infusions for Pain Management in Pediatrics
AbstractLidocaine is an amino amide with a well-established role as a local anesthetic agent. Systemic intravenous administration expands its clinical use to include acute and chronic pain circumstances, such as postoperative pain, neuropathic pain, postherpetic neuralgia, hyperalgesia, visceral pain, and centrally mediated pain. For refractory pain that has not responded to conventional therapy or if further escalation of treatment is prevented by contraindications or side effects to standard therapies, a continuous infusion of lidocaine may be considered as a single intervention or as a sequence of infusions. Here, we re...
Source: Pediatric Drugs - May 26, 2021 Category: Pediatrics Source Type: research
Viloxazine: Pediatric First Approval
This article summarizes the milestones in the development of viloxazine leading to this first pediatric approval for ADHD. (Source: Pediatric Drugs)
Source: Pediatric Drugs - May 26, 2021 Category: Pediatrics Source Type: research
Enhancing Mood, Cognition, and Quality of Life in Pediatric Multiple Sclerosis
AbstractPediatric-onset multiple sclerosis (POMS), representing approximately 5% of all MS cases, affects the central nervous system during its ongoing development. POMS is most commonly diagnosed during adolescence but can occur in younger children as well. For pediatric patients with MS, it is critical to manage the full impact of the disease and monitor for any effects on school and social functioning. Disease management includes not only disease-modifying therapies but also strategies to optimize wellbeing. We review the interventions with the highest evidence of ability to improve the disease course and quality of lif...
Source: Pediatric Drugs - May 17, 2021 Category: Pediatrics Source Type: research
