Journal of Pediatric Pharmacology and Therapeutics最新文献

{"title":"Identification and Characterization of Mitragynine or 7-Hydroxymitraynine Oral Dosage Form Products That Appeal to Children.","authors":"C Michael White, Mia Atallah, Dana El Khoury","doi":"10.5863/JPPT-25-00082","DOIUrl":"https://doi.org/10.5863/JPPT-25-00082","url":null,"abstract":"<p><strong>Objective: </strong>Kratom is the pulverized dried leaves of the <i>Mitragyna speciosa</i> tree and has a bitter taste and high ingestion volume that repels children. Newer products use a single alkaloid extract from the leaves, mitragynine, or oxidize mitragynine to 7-hydroxymitragynine and place it in various oral dosage forms. We identified oral dosage form products containing mitragynine and/or 7-hydroxymitragynine that are marketed in ways that appeal to children and define their alluring characteristics.</p><p><strong>Methods: </strong>We performed Google searches to identify websites selling kratom products. Products were assessed and included if they had 1 or more features that would be attractive to children and defined their formulations, alkaloids, flavoring/scents, mascots, and packaging.</p><p><strong>Results: </strong>Eighty unique products that appealed to children were found, and 36.3% were gummies, 28.8% were tablets, 18.8% were drink mixes or liquids, 15.0% were miscellaneous candies (saltwater taffies, ice cream cones, noobs, popping crystals, honey sticks, mints, lollipops), and 1.3% were chocolates. Thirty-eight products (47.5%) contained mitragynine, 35 products (43.8%) contained 7-hydroxymitragynine, 6 products (7.5%) contained both, and 1 product (1.3%) did not specify which alkaloid was included. Twenty-six products (32.5%) had a cartoon mascot or symbol. Sixty-six products (82.5%) had brightly colored packaging, 59 products (73.8%) had brightly colored formulations, and 73 formulations (91.3%) had a flavor or scent.</p><p><strong>Conclusions: </strong>Mitragynine and 7-hydroxymitragynine are present in many products that could cause small children and teens to be exposed.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"238-242"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692878","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":"Pediatric Antibiotic Prescribing Patterns From Emergency Department Visits.","authors":"Scott Gutovitz, Sarah Astrab, Hannah Chotiner, Justin Blaskowsky, Sarah Meier, Hannah Minton, Lauren Jacobs, Alexis Chlada, Sarah Kleist","doi":"10.5863/JPPT-25-00007","DOIUrl":"https://doi.org/10.5863/JPPT-25-00007","url":null,"abstract":"<p><strong>Objectives: </strong>Antibiotics are frequently prescribed for pediatric emergency department (ED) patients having respiratory or genitourinary infections. Professional guidelines and antibiograms exist to help guide appropriate antibiotics for these infections, but it is unknown how well ED providers adhere to these recommendations.</p><p><strong>Methods: </strong>From January 1, 2017 to December 31, 2022 using a national electronic medical record database, we retrospectively reviewed de-identified pediatric ED patients who were discharged home with an antibiotic. Antibiotics and infections were grouped for analysis, and results were compared yearly.</p><p><strong>Results: </strong>We identified 85,026 pediatric ED patients with infectious diseases discharged home with 24,363 antibiotic prescriptions. Over the 6-year study period, penicillin-based antibiotics were prescribed more than macrolides or cephalosporins for respiratory tract infections, rising from 76.5% in 2017 to 81.3% in 2022 (p < 0.001). For genitourinary tract infections, cephalosporins were prescribed more than 5 other types of antibiotics, rising from 62.7% in 2017 to 73.9% in 2022 (p < 0.001).</p><p><strong>Conclusions: </strong>Over this 6-year period, ED providers in our region were fairly adherent to and improved for guideline recommended respiratory tract infections and antibiogram guided treatment for genitourinary tract infection in pediatric patients.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"251-255"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692923","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 Moderate-Course Hydrocortisone for the Prevention of Bronchopulmonary Dysplasia in Premature Infants: A Pilot Study.","authors":"Chyna Sical, Melody Hernandez, Genevra Galura","doi":"10.5863/JPPT-25-00091","DOIUrl":"https://doi.org/10.5863/JPPT-25-00091","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"270-273"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692898","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":"Enoxaparin Dosing and Target anti-Factor Xa Achievement in Infants by Postmenstrual Age.","authors":"Densley Perez, Kristen Mathew","doi":"10.5863/JPPT-25-00079","DOIUrl":"https://doi.org/10.5863/JPPT-25-00079","url":null,"abstract":"<p><strong>Objective: </strong>Currently, there is little literature delineating the optimal doses of enoxaparin required within the premature and infant populations. This study aims to assess the enoxaparin dose needed to achieve therapeutic anti-factor Xa concentrations through stratifying infants by postmenstrual age (PMA).</p><p><strong>Methods: </strong>This is a retrospective, single-center, cohort study of infants who received at least 1 dose of treatment enoxaparin between September 2020 and September 2023. The primary endpoint was dose required to achieve therapeutic anti-factor Xa concentrations stratified by PMA group. Secondary endpoints were time in therapeutic range, average dose throughout course, number of dose adjustments and rates of bleeding and acute kidney injury.</p><p><strong>Results: </strong>Eighty-four patient encounters met inclusion criteria in which there were 108 unique courses of enoxaparin. Subjects were primarily of term gestation (median 37.5 weeks) and admitted for congenital heart disease (79.8%). The dose needed to achieve the first therapeutic anti-factor Xa concentration by course was significantly different based on PMA (p < 0.001): median 1.80 mg/kg (IQR 1.53-2.20 mg/kg) with PMA < 40 weeks, 1.64 mg/kg (IQR 1.55-1.77 mg/kg) with PMA 40 to 44 weeks and 1.49 mg/kg (IQR 1.19-1.74 mg/kg) with PMA >44 weeks. The median time in therapeutic range was 71% (IQR 53%-90%) per course. Overall, there were 6 cases of bleeding (5 were classified as minimal and none as severe).</p><p><strong>Conclusions: </strong>Subjects with lower postmenstrual ages required significantly higher enoxaparin doses to achieve therapeutic anti-factor Xa concentrations. Postmenstrual age may provide a more appropriate basis for dosing enoxaparin compared with gestational age and postnatal age.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"219-225"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692903","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":"Hypotonia and Lethargy as Potential Adverse Effect to Nirsevimab Administration in a Newborn Infant.","authors":"Virginia María Velasco Molina, María Nimo Mallo, Samantha Tandrón Del Río, Paloma López-Ortego, Gonzalo Solís-García","doi":"10.5863/JPPT-25-00013","DOIUrl":"https://doi.org/10.5863/JPPT-25-00013","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) is one of the most common causes of acute lower respiratory tract infections in children. Immunization with nirsevimab has had a positive impact in reducing the number of emergency department (ED) visits for RSV. Clinical trials have shown that most adverse events associated with nirsevimab administration were mild, with no significant difference compared with placebo. We report on a 13-day-old female newborn who was brought into the ED because of hypotonia and unresponsiveness after administration of nirsevimab. During the 48-hour hospital stay, the only relevant clinical finding was mild axial hypotonia, which gradually resolved without treatment. A cerebral function monitor showed a continuous normal voltage tracing with no signs of seizures, and a complete electroencephalogram revealed normal background activity. Given that all the investigations were normal and the main event preceding the events was the administration of immunoprophylaxis with nirsevimab, a possible association between the clinical symptoms and the medication was suggested. Although there is robust evidence to recommend nirsevimab for reducing hospitalizations, we must bear in mind that, as a relatively new drug, we believe it is essential to emphasize continued monitoring of side effects, particularly in neonates.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"262-265"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692926","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":"Stability Study of Compounded Ethanol-Free Buprenorphine Oral Syringes for the Treatment of Neonatal Opioid Withdrawal Syndrome.","authors":"Viren Soni, Samarth A Shah, Walter K Kraft, Gagan Kaushal","doi":"10.5863/JPPT-25-00058","DOIUrl":"https://doi.org/10.5863/JPPT-25-00058","url":null,"abstract":"<p><strong>Objective: </strong>Buprenorphine (BUP) is advantageous in the management of neonatal opioid withdrawal syndrome (NOWS). A widely used BUP formulation for the treatment of NOWS contains 30% ethanol. This study aimed to investigate the stability of BUP in compounded ethanol-free oral syringes.</p><p><strong>Methods: </strong>A 75-mcg/mL BUP solution was prepared by diluting the commercial injectable solution with water for irrigation, transferred into amber oral syringes, and stored at either room temperature (n = 3) and refrigerated (n = 3) conditions. Microbial testing of the compounded oral syringes was performed to determine microbial growth for 24 and 48 hours at 37°C. The stability of BUP was assessed in the compounded syringes was conducted by pH and liquid chromatography-mass spectrometry (LC-MS) analysis after compounding and at 7, 30, and 60 days of storage.</p><p><strong>Results: </strong>The concentration of BUP at all time points was between 90% and 110% of the baseline on day 0. Concentration increased slightly in the oral syringes after day 30, likely due to moisture loss, as there were no degradation peaks observed in chromatograms. There was no microbial growth or visual change observed for the compounded ethanol-free BUP oral syringes. The pH of the oral syringes was consistent through 60 days for both room-temperature and refrigerated samples.</p><p><strong>Conclusion: </strong>Buprenorphine in an ethanol-free formulation is stable and can be easily compounded in pediatric pharmacies. This formulation is appealing for the treatment of NOWS.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"233-237"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692961","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":"Optimizing Pediatric Drug Therapy: Pediatric Pharmacokinetics and Administration Routes.","authors":"Nokwanda Nhlanzeko Ngcobo","doi":"10.5863/JPPT-24-00144","DOIUrl":"https://doi.org/10.5863/JPPT-24-00144","url":null,"abstract":"<p><p>Optimizing pediatric drug therapy requires a comprehensive understanding of the unique pharmacokinetic characteristics in pediatrics, alongside appropriate drug administration routes. This review explores the impact of age-related pharmacokinetic variations, including enzymatic maturation and organ function, on drug absorption, distribution, metabolism, and excretion. The challenges and advantages of various drug administration routes, evaluating their effect on drug efficacy and safety in pediatric populations are also addressed. A multidisciplinary framework is proposed, integrating pharmacokinetic principles with customized drug administration routes and adherence strategies, such as simplified dosing and digital health interventions. Our findings highlight the necessity of a personalized approach to pediatric drug therapy that combines pharmacokinetic insights with practical administration considerations.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"196-205"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692850","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":"State of Vancomycin Dosing in Neonates: An Overview.","authors":"Amanda L Wilkins, Xiao Zhu, Noel Cranswick, Nigel Curtis, Amanda Gwee","doi":"10.5863/JPPT-25-01214","DOIUrl":"https://doi.org/10.5863/JPPT-25-01214","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 2","pages":"284-291"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692994","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":"Concomitant Enalapril and Spironolactone-Induced Hyperkalemia in a Pediatric Patient.","authors":"Sarah Mae Rogado, Jamie M Pinto, Liliana Cruz Hernandez, Stephanie Chin, Anita Siu","doi":"10.5863/JPPT-25-00009","DOIUrl":"10.5863/JPPT-25-00009","url":null,"abstract":"<p><p>Spironolactone is a mineralocorticoid receptor antagonist with potassium-sparing effects used in the management of heart failure to minimize morbidity and mortality. It is typically given in combination with an angiotensin-converting enzyme inhibitor (ACEI) as part of standard management of pediatric heart failure but has limited literature regarding safety and efficacy in this population. We report a case of probable concomitant enalapril and spironolactone-induced hyperkalemia in a 2-month old female. The patient presented with Class III congestive heart failure and was initiated on enalapril and spironolactone. New hyperkalemia (serum potassium concentration 8.9 mEq/L) developed on day 7 after initiation and persisted despite decreases in the spironolactone dose. Persistent hyperkalemia and hyponatremia with a metabolic acidosis led to the discontinuation of spironolactone by day 12 of admission. The hyperkalemia resolved within 72 hours of discontinuation without further interventions. Based on our patient's course, hyperkalemia in a pediatric patient may occur when spironolactone and an ACEI are given concomitantly and resolve upon discontinuation of spironolactone.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"83-87"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12889005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167104","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":"Clopidogrel Dosing Scheme in Pediatric Cardiac Patients 0-24 Months Old Using P2Y₁₂ Reaction Unit Monitoring.","authors":"Pilar Anton-Martin, Carli Coalter, Kathryn DeAvilla, Meredith Ray, Benjamin W Kozyak, Mario Briceno-Medina, Mark Rayburn","doi":"10.5683/JPPT-25-00024","DOIUrl":"10.5683/JPPT-25-00024","url":null,"abstract":"<p><strong>Objective: </strong>The use of clopidogrel for postprocedural primary thromboprophylaxis in pediatric cardiac patients is becoming more common. This study aimed to explore, using P2Y12 reaction unit (PRU) values, whether the currently recommended static low clopidogrel dose of 0.2 mg/kg/day for patients under 24 months is optimal, or if a gradual dosage escalation would be more appropriate; and to propose a hypothetical dosing scheme for clopidogrel thromboprophylaxis in these patients.</p><p><strong>Methods: </strong>Exploratory, retrospective cohort study in cardiac patients 0-24 months old receiving clopidogrel for thromboprophylaxis between 2018 and 2021. Data collected from medical records included patient demographics and diagnoses, clopidogrel dosing and duration, PRU values, concomitant anticoagulant and antiplatelet therapies, adverse events, and outcomes. Exponential and linear regression analyses were employed to model dosage as a function of time using therapeutic PRU values and to identify the best-fit dosing scheme for clopidogrel.</p><p><strong>Results: </strong>Forty-four cardiac patients on clopidogrel for thromboprophylaxis were included. No statistically significant difference was observed between the predicted dosing from the fitted and the referent regressions, indicating that the observed clopidogrel doses that achieved a therapeutic PRU followed a dosing gradient inconsistent with the static low dose (0.2 mg/kg/day) recommended by the Platelet Inhibition in Children On cLOpidogrel (PICOLO) trial during the first 24 months of age.</p><p><strong>Conclusions: </strong>Pediatric cardiac patients may require a gradual escalation of clopidogrel dosing with age, in contrast to the static low dose recommended by the PICOLO trial during the first 24 months of life. An age-based dosing scheme may prove beneficial for this age group. Prospective studies evaluating age-based clopidogrel dosing in this patient population could offer further insight into this relationship.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"30-36"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167116","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}