Journal of Pediatric Pharmacology and Therapeutics最新文献

{"title":"Ganciclovir Therapeutic Drug Monitoring in Critically Ill Pediatric Patients Receiving Continuous Renal Replacement Therapy.","authors":"Christina J Smith, Laura J Walsh, Kyle R Roberts, Sai Karwande","doi":"10.5863/JPPT-25-00042","DOIUrl":"10.5863/JPPT-25-00042","url":null,"abstract":"<p><strong>Objective: </strong>Ideal ganciclovir dosing for the treatment of cytomegalovirus and herpesvirus in children receiving continuous renal replacement therapy (CRRT) is unknown. Available literature regarding ganciclovir pharmacokinetics (PK) in children suggests high interpatient variability and risk of underexposure. Therapeutic drug monitoring (TDM) may be of benefit in pediatric patients to optimize dosing, with a 24-hour area under the curve (AUC₂₄) of 80 to 120 mg·hr/L proposed as the treatment target. Even with TDM, limited data exist to guide dosing in critically ill children requiring CRRT. The goal of this study was to evaluate ganciclovir dosing and PK in critically ill pediatric patients on CRRT.</p><p><strong>Methods: </strong>This retrospective, single-center cohort study reviewed the electronic medical records of patients 17 years of age or younger who received ganciclovir treatment along with drug concentration monitoring in the pediatric intensive care unit (PICU) between July 2022 and July 2023. Data included ganciclovir dose, PK parameters, CRRT modality, as well as effectiveness and safety outcomes.</p><p><strong>Results: </strong>A total of 5 patients (median age, 12 years; IQR, 8.5-14.5) received ganciclovir in the PICU. Patients received continuous venovenous hemodiafiltration at a median clearance rate of 1928 mL/1.73m²/hr (IQR, 1860-2162). A ganciclovir dose of 2.5 mg/kg every 12 hours most frequently resulted in a goal AUC₂₄ of 80 to 120 mg·hr/L.</p><p><strong>Conclusion: </strong>The results of this study show variable ganciclovir drug exposure in critically ill pediatric patients receiving CRRT. Further study is needed to determine appropriate ganciclovir dosing and the role of TDM in this population.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"366-371"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212877","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":"Tiered Approach to Clonidine Dosing to Prevent Dexmedetomidine Withdrawal in Children: A Prospective Pre and Post Interventional Cohort Study.","authors":"Andrea L Heifner, Weng M Lam, Monica Lee, Jennifer N Nguyen, David E McMann, Thao L Nguyen","doi":"10.5863/JPPT-25-00044","DOIUrl":"10.5863/JPPT-25-00044","url":null,"abstract":"<p><strong>Objective: </strong>To determine if implementation of a tiered clonidine dosing protocol reduces the incidence of withdrawal compared with the preintervention phase.</p><p><strong>Methods: </strong>This is a pre- and postinterventional cohort study in which preintervention data were collected for 6 months for baseline incidence of dexmedetomidine withdrawal and institutional practice of clonidine use. This was followed by implementation of an enteral clonidine dosing protocol based on the length of dexmedetomidine infusion and continued data collection for an additional 6 months. Patients were enrolled in both arms after ≥72 hours on dexmedetomidine. Withdrawal was described as tachycardia or hypertension and elevated Withdrawal Assessment Tool-1 or study questionnaire scores.</p><p><strong>Results: </strong>The preintervention phase had 49 patients included in analysis and the intervention phase had 30 patients. Incidence of withdrawal in the overall preintervention vs intervention cohorts was not significantly different, but in patients who received clonidine there was a trend towards less withdrawal in the intervention vs preintervention cohort (36% vs 52%). The hours on dexmedetomidine nor cumulative dexmedetomidine dose differed between the cohorts (161.5 vs 152.8 hours, p = 0.49; 126.34 vs 134.76 mcg/kg, p = 0.54). With implementation of the protocol, more patients were weaned off dexmedetomidine within 24 hours (67% vs 39%, p = 0.06).</p><p><strong>Conclusions: </strong>To the authors' knowledge, this is the first prospective study assessing the use of an enteral clonidine dosing protocol to prevent dexmedetomidine withdrawal in children. With implementation of the protocol a trend towards reduction in withdrawal in the intervention cohort was documented despite faster weaning time with similar dexmedetomidine exposure.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"399-406"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212826","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":"Approach to the Preoperative Pharmacological Management of Catecholamine-Secreting Tumors in Children: A Case Series and Review.","authors":"Olivia Dollimer, Mike Raschka, David Dassenko","doi":"10.5863/JPPT-25-00032","DOIUrl":"10.5863/JPPT-25-00032","url":null,"abstract":"<p><p>Catecholamine-secreting tumors (CSTs) are an uncommon tumor in pediatrics that can result in hypertensive crisis secondary to catecholamine release from the tumor cells. Pheochromocytoma is the tumor type most associated with excessive catecholamine release, but paragangliomas and neuroblastoma tumors can also generate and release excessive amounts of catecholamines. Surgical resection is typically the treatment of choice for these tumor types; however, manipulation during surgical resection can lead to further catecholamine release. If the patient's adrenergic receptors are not fully inhibited before undergoing surgery, the patient is at risk for experiencing additional hypertensive crises and arrhythmias due to the catecholamine release secondary to the surgery. Although studies have identified sequential α- and β-adrenergic blockade as a prerequisite for surgery to minimize the effects of further catecholamine release during resection, there is little guidance regarding medication timing, dosing, and testing to ensure the pediatric patient has adequately suppressed adrenergic receptors before surgery. Further, with recent shortages of the first-line medication treatment options for this indication, it is vital to establish a treatment plan with alternative treatments for use during drug shortages. This case series describes the successful use of enteral phenoxybenzamine and parenteral phentolamine for α-adrenergic blockade, coupled with enteral atenolol and parenteral esmolol or labetalol for β-adrenergic blockade, in 9 pediatric patients with CST before surgical resection of the tumors. Eight patients underwent a phenylephrine challenge, and all demonstrated appropriate α-blockade preceding tumor removal.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"419-426"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212835","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":"Advancements in Respiratory Syncytial Virus (RSV) Prevention and Treatment in Pediatrics.","authors":"J Hunter Fly, Jeremy S Stultz, Lea S Eiland","doi":"10.5863/JPPT-25-00075","DOIUrl":"10.5863/JPPT-25-00075","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) is a major contributor to global morbidity and mortality, disproportionately affecting young children and infants. Annual worldwide estimates suggest more than 30 million cases of lower respiratory infection and 100,000 deaths are attributed to RSV in children younger than 5 years of age, making RSV prevention and treatment a global priority. Recently approved monoclonal antibodies and vaccines for the prevention of RSV in infants and children have the potential to significantly alter disease burden. Disease prevention is paramount as treatments with rigorously proven clinical efficacy are limited, and supportive care remains the primary management strategy for the majority of patients who contract RSV. However, new entities continue to be evaluated for the treatment of RSV in the pediatric population. This review aimed to synthesize and evaluate existing data on the approved RSV preventative therapies nirsevimab, RSVpreF, clesrovimab, and palivizumab. RSV disease, including its spread, virology, diagnosis, clinical presentation, and treatment, is also discussed.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"322-338"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212872","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":"Efficacy and Safety of Tranexamic Acid in Pediatric Trauma: A Systematic Review and Meta-Analysis.","authors":"Mohammed Alsabri, Yahya A Mahmoud, Amira A Aboali, Shree Rath, Mostafa A Khalifa, Hamza A Abdul-Hafez, Ammarah Tariq","doi":"10.5863/JPPT-25-00083","DOIUrl":"10.5863/JPPT-25-00083","url":null,"abstract":"<p><strong>Objective: </strong>Tranexamic acid (TXA) is a widely used antifibrinolytic agent in surgical and trauma settings in adults. This study aimed to evaluate the efficacy and safety of TXA in pediatric trauma patients across various clinical outcomes.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across 4 databases. We included clinical trials and observational studies that reported the use of TXA in pediatric trauma patients (aged ≤18 years). Data extraction and risk-of-bias assessment were performed by independent reviewers. Meta-analyses were conducted with RStudio software.</p><p><strong>Results: </strong>A total of 12 studies (2 randomized controlled trials [RCTs] and 10 observational) involving 66,398 pediatric trauma patients were included. Tranexamic acid was not significantly associated with reduction in hospital mortality (OR = 1.06; 95% CI, 0.32-3.45) but was associated with significantly shorter hospital stays (mean difference [MD] = -1.49; 95% CI, -2.43 to -0.56). The need for emergency mechanical ventilation was higher among the TXA group (OR = 4.29; 95% CI, 2.52-7.31), whereas the need for mechanical ventilation at discharge was lower (OR = 0.23; 95% CI, 0.08-0.64). Tranexamic acid use did not significantly alter the risk of thromboembolic events (OR = 0.72; 95% CI, 0.19-2.79) or poor neurological outcomes (OR = 2.51; 95% CI, 0.86-7.35).</p><p><strong>Conclusion: </strong>Tranexamic acid may reduce hospital length of stay in pediatric trauma patients, with inconsistent effects on mortality and adverse events. Its use should be individualized based on injury severity and resource availability. Further high-quality research is needed to confirm these findings and clarify the role of TXA in pediatric trauma care.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"347-365"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212781","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":"First Infant Desensitization to Liposomal Amphotericin B.","authors":"Maryam Rostamyan, Shirin Chinehkesh, Mahmoud Khodabandeh, Farzad Kompani","doi":"10.5863/JPPT-25-00078","DOIUrl":"10.5863/JPPT-25-00078","url":null,"abstract":"<p><p>Liposomal amphotericin B is the first-line treatment for <i>Visceral leishmaniasis</i>; however, drug hypersensitivity reactions, such as anaphylaxis, can pose significant challenges. Desensitization protocols are an option when alternative treatments are lacking. A 7-month-old female infant presented with persistent fever, pallor, splenomegaly, and laboratory findings suggestive of <i>Visceral leishmaniasis</i> with secondary hemophagocytic lymphohistiocytosis (HLH). After developing anaphylaxis following the first dose of liposomal amphotericin B (3 mg/kg), a 14-step desensitization protocol was successfully implemented, allowing continuation of therapy without complications. After completing the course of treatment, the patient's fever resolved, spleen size normalized, and hematological parameters improved. Causality assessment using the Naranjo scale indicated a \"probable\" adverse drug reaction (score = 6). This case represents the first reported successful use of a standard liposomal amphotericin B desensitization protocol in an infant under 1 year, demonstrating its feasibility and safety in managing anaphylaxis in endemic areas.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"432-436"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212838","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":"A Call for Training Pediatric Practitioners About Industrial Chemicals and Child Health.","authors":"Ruth A Etzel","doi":"10.5863/JPPT-25-01220","DOIUrl":"10.5863/JPPT-25-01220","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"444-448"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212765","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":"Beyond the Headlines: Examining the Evidence Around Acetaminophen and Autism Risk.","authors":"Chad A Knoderer, Serena B Burk, Sherry Luedtke, Michael D Reed","doi":"10.5863/JPPT-26-00048","DOIUrl":"10.5863/JPPT-26-00048","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"456-462"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212797","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":"A Quality Improvement Project to Increase Pharmacist-Initiated Methicillin Resistant <i>Staphylococcus Aureus</i> Nasal Swab PCR for Vancomycin De-Escalation in Pediatric Patients With Respiratory Tract Infections.","authors":"Kimberly James, Trinkal Patel, Kelsey Jensen, Nipunie Rajapakse, Jamie Heyliger, Grace Lee, Ben Anderson, Laura Dinnes","doi":"10.5863/JPPT-25-00080","DOIUrl":"10.5863/JPPT-25-00080","url":null,"abstract":"<p><strong>Objective: </strong>Overuse of broad-spectrum empiric antimicrobials remains common in children hospitalized with respiratory tract infections (RTI). A negative methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) nasal swab (MNS) polymerase chain reaction (PCR) result has been shown to have a high negative predictive value for MRSA in RTI. In this quality improvement (QI) initiative, we developed a pharmacist-driven approach to reduce the duration of empiric vancomycin for RTI in children. The primary aim was the time to de-escalation of vancomycin, and the secondary aim was the reduction in vancomycin monitoring in patients hospitalized with RTI.</p><p><strong>Methods: </strong>Baseline duration of vancomycin therapy was assessed by conducting a retrospective chart review. After root cause analysis and engaging key stakeholders, an electronic health record OurPractice Advisory (OPA) was implemented, prompting pharmacists to order an MNS PCR during order verification for vancomycin with an RTI indication.</p><p><strong>Results: </strong>Preimplementation (01/01/2021 to 08/31/2023) included 89 patients, and 25 postimplementation (09/21/2023 to 05/31/2024). We found a 36% decrease in mean vancomycin duration from 53 to 34 hours after implementation of the pharmacist-driven OPA. Postimplementation, 24% of patients had a vancomycin concentration obtained, compared with 37% preimplementation. No patients were readmitted within 30 days postimplementation, compared with 1 patient preimplementation.</p><p><strong>Conclusions: </strong>This QI initiative provides preliminary data that empiric vancomycin duration in pediatric patients with RTI may be impacted by pharmacist-facing OPA implementation, prompting ordering of MNS PCR at the time of vancomycin verification. This initiative could be replicated at other institutions seeking to reduce empiric vancomycin usage.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"413-418"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212724","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":"Heparin Resistance - A Reality or Fallacy.","authors":"Joshua W Branstetter, Amy L Kiskaddon","doi":"10.5863/JPPT-25-00138","DOIUrl":"10.5863/JPPT-25-00138","url":null,"abstract":"<p><p>The term heparin resistance is often used by clinicians, despite the lack of specific criteria. Defining true heparin resistance remains problematic in both adults and pediatrics, as there is no consensus on a \"maximum\" heparin dose. Furthermore, the indication or setting of heparin use may impact perceptions of what is considered a maximum dose. For example, what might be considered a normal dose in the setting of cardiac surgery might be considered \"high\" in the intensive care unit. There is also a mixed opinion as to the ideal monitoring strategy. Given the lack of a standardized definition and the misunderstandings that exist surrounding the topic of heparin resistance, this review serves to provide insights into heparin resistance in pediatric patients and potential management strategies.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 3","pages":"339-346"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212861","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}