The Journal of Pediatric Pharmacology and Therapeutics最新文献

{"title":"Is Eat, Sleep, Console the New Standard of Care?","authors":"Ricardo J. Rodriguez, Alexandria D. Cremeans Schwartz, Michelle M. Elias Ruiz","doi":"10.5863/1551-6776-28.6.573","DOIUrl":"https://doi.org/10.5863/1551-6776-28.6.573","url":null,"abstract":"","PeriodicalId":22794,"journal":{"name":"The Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136152105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium Assessment Treatment Strategies in Critically Ill Pediatric Patients: A Pediatric Pharmacy Association Practice-Based Research Network Survey Study","authors":"Caitlyn V. Bradford, Mon-Yee Fung, Alexander Wang, Emily C. Benefield, Ferras Bashqoy, Stephen B. Neely, Peter N. Johnson","doi":"10.5863/1551-6776-28.6.540","DOIUrl":"https://doi.org/10.5863/1551-6776-28.6.540","url":null,"abstract":"OBJECTIVES The purpose of this study was to describe overall screening, prevention, and treatments for pediatric delirium at various neonatal intensive care units (NICUs), cardiac intensive care units (CICUs), and pediatric intensive care units (PICUs) from the Pediatric Pharmacy Association (PPA) membership. The primary objective was to identify the number of respondents that had a defined delirium-based protocol. The secondary objectives included identification of delirium assessment tools used, first- and second-line delirium treatment options, and monitoring practices for antipsychotics for delirium management. METHODS A cross-sectional questionnaire was distributed to PPA members from February 8, 2022, to March, 25, 2022. Comparisons between the NICUs, PICUs, and CICUs were conducted by using chi-square tests, with a priori p value of <0.05 RESULTS The questionnaire was completed by 84 respondents at 62 institutions; respondents practiced in the PICU or mixed PICU (n = 48; 57.1%), CICU (n = 13; 15.5%), and NICU (n = 23; 27.4%). Sixty-one respondents (72.6%) noted their units routinely screen for delirium, and there was a significant difference between the respondents of different units that use a delirium scoring tool (p < 0.01). Only 33 respondents (39.3%) had a defined delirium protocol, and there was no difference between units (p = 0.31). The most common agents used for delirium treatment were quetiapine and risperidone. There was variability in the monitoring used between respondents, but the majority (n = 74; 88%) monitor electrocardiograms to assess the corrected QT interval, but practice variability existed. CONCLUSIONS Most respondents did not have a defined delirium protocol. Variations were noted in the treatment options and monitoring for critically ill pediatric patients with delirium.","PeriodicalId":22794,"journal":{"name":"The Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136153321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Precompetitive Space for Drug or Vaccine Development: What Does It Look Like Now and What Could It Look Like in the Future?","authors":"Jeffrey S. Barrett","doi":"10.5863/1551-6776-28.5.465","DOIUrl":"https://doi.org/10.5863/1551-6776-28.5.465","url":null,"abstract":"The pharmaceutical industry including small and large organizations and biotech as well as other stakeholders in the health arena are increasingly aware of the benefits of working together in the precompetitive phase to address common problems. While they rightly remain focused on developing their own independent products and services in healthy competition, there is an increased awareness of the need to improve precompetitive efficiency by identifying and addressing common issues. A major challenge is defining the domain of precompetitive research. The basic biology, the understanding of disease, biomarkers of prognosis, and even drug responses all can be areas of precompetitive research and development (R&D).Precompetitive collaboration allows a group of competing companies to come together to develop a solution for a problem that they all share, and from which none of them would gain a competitive advantage. Although the primary goal is often cited as the development of that solution, the process of conversing and collaborating is in itself of great value, and a project that enables colleagues from across the industry to develop closer working relationships with each other can be beneficial, even if the deliverables do not live up to expectations.Several different precompetitive collaboration types have evolved to date. Collaborations are typically classified regarding whether they have open or restricted participation and open or restricted outputs. They also vary according to their goals. Likewise, there are typically 2 broad collaboration goals: to build enabling platforms and to conduct research. These goals can be further subdivided by the 4 different types of outputs they produce, including the development of standards and tools, the generation and aggregation of data, knowledge creation, and product development.In general, collaborations aimed at building enabling platforms focus on developing standards and tools or generating and aggregating data to achieve a necessary scale for research. Collaborations that conduct research seek to create new knowledge or to turn that knowledge into a product by accessing resources and capabilities across organizations. Barriers to sharing data are often an obstacle. Different data systems, privacy rules, and sharing protocols often make it difficult for community-based organizations in nonmedical sectors to work in concert with health care organizations.Regulatory hurdles, complex research for new drug and vaccine targets, and the low predictability of animal models are some examples of why both drug and vaccine industries are struggling. Such internal and external challenges make it necessary for companies to improve their R&D efficiencies by methods including outsourcing to reduce overhead costs, installation of proof-of-concept organizations, or by enhanced scientific rigor in data-driven project decision-making.1 The recent pandemic also provided a heightened sense of urgency to accelerating coll","PeriodicalId":22794,"journal":{"name":"The Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethanol Lock for Prevention of CVC-Related Bloodstream Infection in Pediatric Patients: A Systematic Review and Meta-Analysis","authors":"Caroline M. Sierra, Cristian Rodriquez, Khaled Bahjri","doi":"10.5863/1551-6776-28.5.386","DOIUrl":"https://doi.org/10.5863/1551-6776-28.5.386","url":null,"abstract":"Ethanol lock therapy (ELT) can be used in patients with an indwelling central line to assist in the prevention of central venous catheter (CVC)–associated infections. However, its efficacy has not been consistently demonstrated in the pediatric population. The primary objective of this review and meta-analysis was to determine the efficacy and safety of ELT in prevention of central line–associated bloodstream infection (CLABSI) in the pediatric population. A search was conducted with the PubMed, CINAHL, PSCYInfo, Cochrane Library, and Academic Search Premier databases from inception through January 21, 2022. Studies were included if they reported incidence of CVC-related infections with ELT in pediatric patients. Meta-analyses used random-effects models according to the heterogeneity of all included studies. Of 736 studies, 25 met inclusion criteria for review and 10 for inclusion in the meta-analysis. Meta-analysis with pre- and post-ELT treatment showed that use of ELT significantly decreased mean CVC-related infections when compared with pre-treatment with no ELT with a mean difference of −5.79 (95% CI, −9.08 to −2.51; p < 0.001). The number of CVC infections also significantly decreased (OR, 0.42; 95% CI, 0.23–0.75; p = 0.004). Increased risk of thrombosis and increased frequency of catheter breakage, repair, and replacement were noted in several studies. Ethanol lock therapy is effective in preventing infection related to central venous catheter use in pediatric patients. Further study is warranted to determine the optimal protocol for, and incidence of, adverse events related to use of ELT.","PeriodicalId":22794,"journal":{"name":"The Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Overview of Type B Lactic Acidosis Due to Thiamine (B1) Deficiency","authors":"Kaitlyn J. Agedal, Kelly E. Steidl, Jeni L. Burgess","doi":"10.5863/1551-6776-28.5.397","DOIUrl":"https://doi.org/10.5863/1551-6776-28.5.397","url":null,"abstract":"Type B lactic acidosis can occur secondary to several factors, including thiamine deficiency, and is not as common as type A. Recognizing thiamine deficiency–associated lactic acidosis is challenging because serum thiamine concentrations are not routinely obtained, and a thorough and specific history is necessary for clinicians to suspect thiamine deficiency as a root cause. Furthermore, the appropriate dose and duration of thiamine treatment are not well defined. Untreated thiamine deficiency–associated lactic acidosis can lead to critical illness requiring lifesaving extracorporeal therapies. Additionally, if thiamine and glucose are not administered in an appropriate sequence, Wernicke encephalopathy or Korsakoff syndrome may occur. This review aims to summarize therapeutic treatment for thiamine deficiency–associated lactic acidosis, based on case reports/series and nutritional guidance. After a literature search of the PubMed database, 63 citations met inclusion criteria, of which 21 involved pediatric patients and are the focus of this review. ­Citations describe dosing regimens ranging from 25 to 1000 mg of intravenous (IV) thiamine as a single dose, or multiple daily doses for several days. Specific guidance for critically ill adults recommends a thiamine range of 100 mg IV once daily to 400 mg IV twice daily. Although there are no specific recommendations for the pediatric population, given the relative safety of thiamine administration, its low cost, and our review of the literature, treatment with thiamine 100 to 200 mg IV at least once is supported, with ongoing daily doses based on clinical response of the patient, regardless of age.","PeriodicalId":22794,"journal":{"name":"The Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134934818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Dual- Versus Mono-Sedative Therapy on Opioid Administration, Sedative Administration, and Sedation Level in Mechanically Ventilated, Critically Ill Children","authors":"Kanecia O. Zimmerman, Daniel Westreich, Michele Jonsson Funk, Daniel K. Benjamin, David Turner, Til Stürmer,","doi":"10.5863/1551-6776-28.5.409","DOIUrl":"https://doi.org/10.5863/1551-6776-28.5.409","url":null,"abstract":"OBJECTIVE We estimated the effect of early initiation of dual therapy vs monotherapy on drug administration and related outcomes in mechanically ventilated, critically ill children. METHODS We used the electronic medical record at a single tertiary medical center to conduct an active comparator, new user cohort study. We included children <18 years of age who were exposed to a sedative or analgesic within 6 hours of intubation. We used stabilized inverse probability of treatment weighting to account for confounding at baseline. We estimated the average effect of initial dual therapy vs monotherapy on outcomes including cumulative opioid, benzodiazepine, and dexmedetomidine dosing; sedation scores; time to double the opioid or benzodiazepine infusion rate; initiation of neuromuscular blockade within the first 7 days of follow-up; time to extubation; and 7-day all-cause in-hospital death. RESULTS The cohort included 640 patients. Children receiving dual therapy received 0.03 mg/kg (95% CI, 0.02–0.04) more dexmedetomidine over the first 7 days after initiation of mechanical ventilation than did monotherapy patients. Dual therapy patients had similar sedation scores, time to double therapy, initiation of neuromuscular blockade, and time to extubation as monotherapy patients. Dual therapy patients had a lower incidence of death. CONCLUSIONS In this study, initial dual therapy compared with monotherapy does not reduce overall drug administration during mechanical ventilation. The identified effect of dual therapy on mortality deserves further investigation.","PeriodicalId":22794,"journal":{"name":"The Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134935068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-Induced Hepatitis in an Adolescent During Concomitant Use of Azithromycin and Lisdexamfetamine Dimesylate","authors":"William A. Mabry, Linda F. Lazar, Kelly S. Bobo, Chasity M. Shelton","doi":"10.5863/1551-6776-28.5.460","DOIUrl":"https://doi.org/10.5863/1551-6776-28.5.460","url":null,"abstract":"This case report describes a 14-year-old male with signs and symptoms of drug-induced hepatotoxicity after receiving azithromycin and lisdexamfetamine dimesylate. The patient was admitted to the hospital and a liver biopsy revealed findings suggestive of drug-induced hepatitis. In this patient, it is unclear whether 1 agent individually or a combination of azithromycin and lisdexamfetamine was the cause of hepatitis. Although hepatotoxicity has been reported with azithromycin and other macrolide antibiotics in adults, such a condition has yet to be reported in pediatrics. In light of this report, providers should be aware of a potentially rare reaction of acute hepatitis when combining azithromycin and lisdexamfetamine in pediatric patients.","PeriodicalId":22794,"journal":{"name":"The Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136117806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ChatGPT for Research and Publication: A Step-by-Step Guide","authors":"Som S. Biswas","doi":"10.5863/1551-6776-28.6.576","DOIUrl":"https://doi.org/10.5863/1551-6776-28.6.576","url":null,"abstract":"","PeriodicalId":22794,"journal":{"name":"The Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136152115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Frequency of Culture-Positive Late Onset Sepsis With the Use of Ceftazidime Versus Cefotaxime in the NICU","authors":"Jenna Salter, Van Tran, David Bastawrous, Andrew Nuibe","doi":"10.5863/1551-6776-28.6.553","DOIUrl":"https://doi.org/10.5863/1551-6776-28.6.553","url":null,"abstract":"OBJECTIVE As broader spectrum antibiotics have been associated with adverse effects, our study evaluated whether the frequency of culture-positive late-onset sepsis (LOS) and multidrug resistant (MDR) infections were increased with the use of ceftazidime as compared with cefotaxime in the neonatal intensive care unit (NICU). METHODS This was a multihospital, retrospective chart review of patients who received at least 24 hours of ceftazidime or cefotaxime in the NICU between December 1, 2012 and August 31, 2021. Patients were excluded from analysis if they expired during the admission, had an incomplete history, positive cultures for an MDR infection prior to receiving either antibiotic, or received the alternate antibiotic within the same treatment course. RESULTS A total of 334 patients were included for analysis (ceftazidime, n = 147; cefotaxime, n = 187). The average birth weight was lower in the ceftazidime cohort compared with the cefotaxime cohort [1.46 kg (95% CI, 1.29–1.63 kg) versus 1.93 kg (95% CI, 1.75–2.11 kg), p = 0.0002] with a corresponding lower gestational age [28.9 weeks (95% CI, 28.0–29.9 weeks) versus 31.7 weeks (95% CI, 30.8–32.6 weeks), p = 0.0001]. Adjusting for baseline differences showed a protective effect for ceftazidime (OR = 0.32; 95% CI, 0.16–0.62; p = 0.0009). There was no statistically significant difference in the frequency of MDR infections between the cohorts (OR = 0.25; 95% CI, 0.053–1.14; p = 0.07), however this study was underpowered to detect the difference noted. CONCLUSIONS Ceftazidime appears to be a safe and effective alternative treatment option compared with cefotaxime in the NICU with no increase in the risk of culture-positive LOS or MDR infections.","PeriodicalId":22794,"journal":{"name":"The Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136153095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}