Journal of Pediatric Pharmacology and Therapeutics最新文献

{"title":"Pharmacology of Bacteriophage Therapy in Children: A Re-Emerging Paradigm in Antibacterial Therapy.","authors":"Jennifer Le, John S Bradley, Nanda Ramchandar","doi":"10.5863/JPPT-25-00151","DOIUrl":"10.5863/JPPT-25-00151","url":null,"abstract":"<p><p>The rise of antibiotic-resistant bacteria has reignited global interest in bacteriophages as potential therapeutic agents. Bacteriophage (phage) therapy provides an alternative to conventional antibiotics to treat serious infections caused by multidrug-resistant pathogens. In this narrative review, we explore the pharmacokinetics (PK), pharmacodynamics (PD), and clinical use of phage therapy in pediatric populations. We conducted PubMed searches for relevant publications from 1959 to September 2025. In contrast to most drugs, phages are self-replicating in the presence of target bacteria, necessitating the use of non-linear, dynamic pharmacology models to integrate phage-bacteria interaction (which can fluctuate over time, based on the presence of susceptible bacteria), as well as host factors such as immune clearance of phages and traditional host mechanisms of clearance of invasive bacterial pathogens. Phages are primarily cleared through the reticuloendothelial system, particularly in the liver and spleen. Advantages of phage therapy over antibiotics include a promising safety profile, preservation of the child's own microbiome, and, compared with some antibiotics, enhanced penetration into biofilms. Our knowledge of the benefits and risks of phage therapy is limited largely to current pediatric case reports and case series. The clinical use spans a wide breadth of clinical infections, mostly involving poorly responsive infections caused by multidrug-resistant bacteria. Until robust, prospective PK-PD and clinical trial data become available to guide therapy, phage therapy should be administered under protocols with individualized dosing and rigorous safety monitoring. Clinical applications using standardized, evidence-based dosing regimens and outcome assessments require further evaluation.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"483-492"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Heart-Rate Response Following Atropine Administration During Bradycardic Events in Infants: Fixed Minimum Dose Versus Weight-Based Dose.","authors":"Elyse M Schwab-Daugherty, Jeremy J Daugherty, Erin Hohenstein, Pamela D Reiter","doi":"10.5863/JPPT-25-00084","DOIUrl":"10.5863/JPPT-25-00084","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to compare the change in heart rate (HR) in patients less than 5 kg who received either the fixed minimum dose of atropine (0.1 mg) or the weight-based dose of atropine (0.02 mg/kg).</p><p><strong>Methods: </strong>This was a retrospective, single organization, dual-site cohort study of infants less than 5 kg who received atropine in the setting of a bradycardic event from January 1, 2014 to December 31, 2024. Patients were excluded if they received atropine for any other indication. Age at the time of atropine administration, gender, race, weight, and department location within the hospital, mean arterial pressure, and other resuscitative medications were collected.</p><p><strong>Results: </strong>A total of 36 atropine doses (representing 33 unique patients) met study inclusion. Twenty-seven administration events (75%) were provided as a weight-based dose with no minimum while 9 administration events (25%) were provided as a minimum dose of 0.1 mg. The mean change in HR from time of atropine administration to 5 minutes after atropine was 53.9 ± 37.7 beats per minute for patients who received the weight-based dose of atropine compared with 50.4 ± 18.4 beats per minute for patients who received the minimum dose of atropine (p = 0.864).</p><p><strong>Conclusions: </strong>Heart rate response following intravenous atropine to infants less than 5 kg at either 0.02 mg/kg or a minimum dose of 0.1 mg did not statistically differ.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"529-534"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Vancomycin Trough Concentrations in Pediatric Patients with and without Sickle Cell Disease: A Cohort Study in Saudi Children.","authors":"Sohail Azam, Kholoud Alrashed, Muna Almijmaj, Zainab Almaa, Fatima Eltayeb Hago, Amani Yahya Bakri","doi":"10.5863/JPPT-25-00124","DOIUrl":"10.5863/JPPT-25-00124","url":null,"abstract":"<p><strong>Objective: </strong>Sickle cell disease (SCD) is associated with altered renal function, particularly glomerular hyperfiltration, which may increase vancomycin clearance and result in subtherapeutic drug exposure. Limited data exist on vancomycin pharmacokinetics in non-ICU pediatric SCD patients. The objective of this research is to compare vancomycin trough concentrations and dosing requirements between pediatric patients with and without SCD.</p><p><strong>Method: </strong>A retrospective cohort study compared two groups-pediatric non-ICU patients with SCD (n=29) and without SCD (n=58)-assessing initial and repeated trough concentrations, dosing regimens, and renal function. The data was collected over 10-year (2014-2024).</p><p><strong>Results: </strong>Among the 87 included patients, 29 were SCD patients and 58 were without SCD Initial serum vancomycin trough concentrations were significantly lower in SCD patients compared to non-SCD patients (5.43 ± 2.61 vs. 10.62 ± 4.71 mg/L; p < 0.00001). Despite dose adjustments, troughs remained lower in SCD patients (10.30 ± 3.61 vs. 13.10 ± 3.73 mg/L; p = 0.0023). SCD patients required higher adjusted doses (64.2 ± 10.0 vs. 58.3 ± 12.0 mg/kg/day). Multiple regression confirmed SCD status as an independent predictor of lower trough concentrations (β = -4.40; p < 0.001).</p><p><strong>Conclusion: </strong>Pediatric patients with SCD exhibit significantly lower serum vancomycin trough concentrations and require higher dosing to achieve therapeutic target concentrations. Early therapeutic drug monitoring and individualized dosing strategies are recommended to minimize subtherapeutic exposure and optimize antimicrobial efficacy in this high-risk population.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"535-539"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Formulary Change and Implementation of a Legacy Medication Alternative in the Electronic Medical Record on Antibiotic Prescribing In Children.","authors":"Hailey Kemp, Kalen B Manasco","doi":"10.5863/JPPT-25-00069","DOIUrl":"10.5863/JPPT-25-00069","url":null,"abstract":"<p><strong>Objective: </strong>To assess prescribing patterns following an oral cephalosporin formulary change and the implementation of a legacy medication alternative in the electronic medical record to discourage prescribing cefdinir when de-escalating intravenous ceftriaxone to an enteral antibiotic in pediatric patients.</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study of hospitalized pediatric patients who received at least 1 dose of ceftriaxone de-escalated to an enteral antibiotic for the treatment of community-acquired pneumonia, upper respiratory tract infection, or urinary tract infection. Patients from a 6-month period post-formulary change were compared with a historical cohort from the same timeframe, 1 year prior. The primary outcome was the change in cefdinir prescribing. Secondary outcomes included the rate of optimal antibiotic de-escalation before and after the interventions, hospital length of stay, and hospital re-encounter rates.</p><p><strong>Results: </strong>A total of 134 patients were included. Cefdinir prescribing occurred in 44% and 34% (p = 0.287) of patients pre- and post-intervention, respectively. Optimal enteral antibiotic de-escalation occurred in 46 (62%) patients pre-intervention and 43 (72%) post-intervention (p = 0.245). Rates of optimal de-escalation were lowest for patients treated for urinary tract infection (< 60% in both cohorts), with cefdinir used in 48% of these cases. Hospital re-encounters occurred in 6 (8%) patients pre-intervention and 0 (0%) post-intervention (p = 0.035). Median length of stay was significantly reduced (p = 0.038) post-intervention, driven by a 1-day reduction in patients treated for community-acquired pneumonia (p = 0.013).</p><p><strong>Conclusions: </strong>After the formulary changes involving cefdinir, there was no significant decrease in cefdinir use or in optimal de-escalation rates. There were significantly lower hospital re-encounters and shorter lengths of stay, though further studies are needed to validate these findings.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"509-515"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Doses, Big Problems: Antidote Shortages.","authors":"Daniel Ascher Laub, Maryann Mazer-Amirshahi, Michelle Burns, Erin R Fox","doi":"10.5863/JPPT-25-00153","DOIUrl":"10.5863/JPPT-25-00153","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"574-576"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voriconazole and Dexamethasone Drug Interaction in a Premature Neonate.","authors":"Caren J Liviskie, Christine R Lockowitz, Christopher C McPherson, Melissa M Riley, David A Hunstad","doi":"10.5863/JPPT-25-00085","DOIUrl":"10.5863/JPPT-25-00085","url":null,"abstract":"<p><p>Neonatal invasive fungal infections (IFI) from <i>Aspergillus</i> species are increasing in frequency. While voriconazole remains the antifungal of choice for treatment in many patient populations, several pharmacokinetic challenges affect dosing of voriconazole in premature neonates. Further complicating voriconazole use are the unknown implications of drug interactions in the preterm population. We report a case of voriconazole use in a neonate for the treatment of cutaneous <i>Aspergillosis</i> with variable serum voriconazole concentrations, reflecting a suspected drug interaction with dexamethasone. Serum voriconazole concentrations were initially subtherapeutic despite multiple dose escalations, then unexpectedly increased to supratherapeutic range as a concomitant dexamethasone course was tapered. Re-initiation of voriconazole after discontinuation of dexamethasone resulted in supratherapeutic concentrations that were discordant from previous serum concentrations on the same voriconazole dose while receiving dexamethasone. This is the first report of a potential drug interaction between voriconazole and a corticosteroid in a preterm neonate, highlighting the importance of drug interactions in voriconazole dosing evaluation and monitoring in this population.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"553-556"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Dangers of Adult Cosmetics to Preteen and Teenage Girls.","authors":"Kate E Myers, Talia Thomas, Gregory L Kearns","doi":"10.5863/JPPT-26-X0113","DOIUrl":"10.5863/JPPT-26-X0113","url":null,"abstract":"<p><p>Cosmetic use among preteens and adolescents is increasingly common, fueled by social media trends and marketing campaigns that blur the lines between childhood innocence and adult beauty culture. Although these products are often marketed as safe, many contain chemicals of concern, including endocrine-disruptions agents, allergens, and potential carcinogens. Early and prolonged exposure during critical stages of growth raises important questions about immediate and long-term health consequences. Children and teenagers are particularly vulnerable because their skin barrier is thinner and more permeable than that of adults, allowing greater absorption of harmful substances. Endocrine-disrupting chemicals interfere with normal hormonal pathways, potentially altering physical development and reproductive health. Fragrances and preservatives may provoke allergic or irritant reactions, leading to dermatologic conditions such as contact dermatitis and acne exacerbation. Cumulative exposure over years may also increase the risk of cellular damage or malignancy. Beyond physical effects, cosmetic use during adolescence carries psychosocial implications. Engagement with appearance-focused products reinforces unattainable beauty ideals, heightens self-consciousness, and may increase anxiety, body dissatisfaction, and eating-disorder behaviors. These risks are amplified by advertising practices that emphasize perfection while concealing potential harms. Strengthening regulation, ingredient transparency, age-specific safety testing, and public health education is needed to safeguard adolescent well-being.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"466-470"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Opioid Administrations After Laparoscopic Appendectomy in Pediatrics With Perforated Versus Non-perforated Appendicitis: A Retrospective Cohort Study.","authors":"Rachel Branton, Elizabeth Farrington","doi":"10.5863/JPPT-25-00076","DOIUrl":"10.5863/JPPT-25-00076","url":null,"abstract":"<p><strong>Objective: </strong>Laparoscopic appendectomy is the primary treatment of appendicitis, but multimodal pain regimens are necessary to improve postoperative outcomes and optimize pain control. There are limited data comparing the analgesic requirements between perforated and non-perforated appendicitis and whether perforation requires more opioids due to its complications. The objective of this research is to compare the quantity of opioid administrations in perforated and non-perforated appendicitis following laparoscopic appendectomy to see if there is a difference in analgesic requirements.</p><p><strong>Methods: </strong>This retrospective, cohort study included pediatric patients that underwent laparoscopic appendectomy for perforated and non-perforated appendicitis. Patients were evaluated from May 4, 2024 through December 31, 2024. The number of administrations of opioids, acetaminophen, and non-steroidal anti-inflammatory drugs were evaluated with binary χ² test and Mann-Whitney <i>U</i> test.</p><p><strong>Results: </strong>A total of 60 patients were included, with 30 perforated appendicitis and 30 non-perforated appendicitis. Opioids were administered in 50% of perforated and 56.7% of non-perforated appendicitis patients (p = 0.79). A negative binomial regression showed perforated patients administered opioids received 1.58 times the number of opioid administrations on average (p = 0.19) and for each additional year of age, the expected number of opioid administrations increased by 11% (p = 0.05). The median number of non-opioid analgesic administrations were statistically significant in perforated appendicitis patients versus non-perforated, with 2.5 acetaminophen administrations versus 1 (p = 0.002) and 8 NSAID administrations versus 1 (p < 0.001).</p><p><strong>Conclusions: </strong>The number of opioids administered were similar across groups, but perforated appendicitis patients utilized more acetaminophen.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"523-528"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Safety of Medications During Lactation: Lactation safety.","authors":"Philip O Anderson","doi":"10.5863/JPPT-26-00104","DOIUrl":"10.5863/JPPT-26-00104","url":null,"abstract":"<p><p>Clinicians are often faced with the dilemma of having to decide if a drug is safe for a mother to take while she is breastfeeding her infant. This is particularly difficult with a relatively new drug because information on breastmilk excretion or use during lactation is rarely available. This article reviews the measures used to assess the safety of drugs during breastfeeding and provides some practical guidance on their use.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"577-581"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunological Aspects Allergic Laryngitis: Role of Cellular and Humoral Mechanisms Directing Therapeutic Strategies.","authors":"Maria Zofia Lisiecka, Joanna Luczak","doi":"10.5863/JPPT-25-00127","DOIUrl":"10.5863/JPPT-25-00127","url":null,"abstract":"<p><p>The aim of the study was to analyze the cellular and humoral mechanisms underlying the development of allergic laryngitis, to identify key diagnostic markers, and to evaluate the effectiveness of contemporary therapeutic approaches. The study examined the principal pathogenetic mechanisms of the disease, with particular emphasis on the Th2-mediated immune response, the role of cytokines <i>IL-4, IL-5,</i> and <i>IL-13</i>, immunoglobulin E (IgE), and mast cell degranulation, as well as current diagnostic methods, including laryngoscopy, skin testing, spirometry, and immunological assays. The findings confirm the leading role of Th2-dependent inflammation and IgE-mediated reactions in the development of laryngeal inflammation. The study concludes that allergen-specific immunotherapy combined with antihistamines and inhaled glucocorticosteroids is highly effective in improving symptom control and reducing the risk of relapse, supporting the integration of immunological markers and instrumental diagnostic methods to enhance diagnostic accuracy and enable personalized treatment strategies.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 4","pages":"471-482"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}