Children and Adults

Generally the azoles are well tolerated in children and adults mild side effects like nausea and vomiting are seen in <5% of the patients treated with FLU. 

The main indication for certain psychostimulants is ADHD in children and adults [4]. Recent research shows that the clinical effect and benefit are dramatic even in adults. About 60% of adult patients receiving stimulant medication showed moderate-to-marked improvement, as compared with 10% of those receiving placebo. The core symptoms of hyperactivity,... 

Nomogram for Estimating Body Surface Area of Older Children and Adults... 

Appendix E contains two body surface area nomograms—one for infants and young children and one for older children and adults. 

Guzelian PS, Henry CJ, Olin SS. 1992. Similarities and differences between children and adults Implications for risk assessment. Washington, DC International Life Sciences Institute Press. 

Studies in animals and autopsy findings of endosulfan and metabolites in various tissues in humans suggest that absorbed endosulfan is most readily distributed to adipose and brain tissue, but that the liver and kidney may be longer-term repositories of endosulfan and its metabolites. Endosulfan residues were found in fat of hospitalized Spanish children (Olea et al. 1999), but no studies were located regarding known or suspected differences between children and adults with respect to endosulfan distribution. 

Renal excretion is the most important endosulfan elimination route in humans and animals. Biliary excretion has also been demonstrated to be important in animals. Estimated elimination half-lives ranged between approximately 1 and 7 days in adult humans and animals. Endosulfan can also be eliminated via the breast milk in lactating women and animals, although this is probably a relatively minor elimination route. No studies were located regarding known or suspected differences between children and adults with respect to endosulfan excretion. 

Brockow K, Akin C, Huber M. Metcalfe D Assessment of the extent of cutaneous involvement in children and adults with mastocytosis relationship to symptomatology, tryptase levels, and bone marrow pathology J Am Acad Dermatol 2003 48 508-516. 

The indication for venom immunotherapy is based on a history of systemic allergic reactions to Hymenoptera stings and positive diagnostic tests, skin tests and/or venom-specific serum IgE antibodies [45, 49]. In the presence of only mild systemic allergic reactions, limited to the skin, immunotherapy is not generally recommended in the USA not for children, in Europe not for children and adults, unless they are heavily exposed and had repeated such reactions. 

The rate of non-lgE-mediated immediate hypersensitivity reactions usually varies between 20 and 50% [1-7, 9], They are assumed to result from direct non-specific mast cell and basophil activation, which causes direct histamine release [19], Histamine release is predominantly found with the use of the benzylisoquinoUnes d-tubocurarine, atracurium and mivacurium, and the aminosteroid rapacuronium. Severe bronchospasm related to rapacuronium administration has been reported in children and adults. It might be related to the higher affinity of rapacuronium for M2 versus M3 muscarinic receptors [20]. Rapacuronium has been withdrawn from the market in the USA. 

Evaluate the patient s stool patterns. Steatorrhea indicates suboptimal enzyme replacement or non-compliance. Infants should have two to three well-formed stools daily, while older children and adults may have one or two stools. 

Once an acute diarrheal situation ensues, patients typically eat less as they become focused on the diarrhea. Both children and adults should attempt to maintain nutritional intake. Food provides not only nutrients but also fluid volume that helps replace what is lost. However, food-related fluid may not be enough to compensate for diarrheal losses. Some foods may be inappropriate if they irritate the gastrointestinal tract or if they are implicated as the cause of the diarrhea. Patients with chronic diarrhea may find that increasing bulk in the diet may help (e.g., rice, bananas, whole-wheat, and bran). 

National Institute for Clinical Excellence. The Epilepsies The Diagnosis and Management of the Epilepsies in Children and Adults in Primary and Secondary Care http //www.nice.org.uk/ pdf/CG020NICEguideline.pdf. Accessed December 20, 2005. 

Atomoxetine is the most recent addition to the ADHD armamentarium in both children and adults. In clinical studies, atomoxetine has demonstrated superior efficacy over placebo and equivalent efficacy when compared with a suboptimal immediate-release methylphenidate dose.17 20 However, it is not clear whether atomoxetine is superior to typical methylphenidate doses or other stimulant formulations. Atomoxetine may be used as a second- or third-line medication for ADHD. 

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (1) family and social relationships, (2) disruptive behavior, (3) completing required tasks, (4) self-motivation, (5) appearance, and (6) self-esteem. It is very important to elicit evaluations of the patient s behavior from family, school, and social environments in order to assess the preceding. Using standardized rating scales (e.g., Conners Rating Scales-Revised, Brown Attention-Deficit Disorder Scale, and IOWA Conners Scale) in both children and adults with ADHD helps to minimize variability in evaluation.29 After initiation of therapy, evaluations should be done every 2 to 4 weeks to determine efficacy of treatment, height, weight, pulse, and blood pressure. Physical examination or liver function tests may be used to monitor for adverse effects. 

FIGURE 40-2 Glycemic control algorithm for type 2 DM in children and adults. (Adapted with permission, from DiPiro... 

Congenital hypothyroidism is still seen in the United States, and all newborns in the United States undergo screening with a TSH level. As soon as the hypothyroid state is identified, the newborn should receive the full LT4 replacement dose. The replacement dose of LT4 in children is age-dependent. In newborns, the usual dose is 10 to 17 mcg/kg per day. LT4 tablets may be crushed and mixed with breast milk or formula. Serum FT4 levels (target 1.6-2.2 ng/dL or 20.59-28.31 pmol/L) are used for dose titration in infants because the TSH level may not respond to treatment as it does in older children and adults. By 6 months of age, the required dose is reduced to 5 to 7 mcg/kg per day, and from ages 1 to 10 years, the dose is 3 to 6 mcg/kg per day. After age 12, adult doses can be given. 

Identify the clinical features of children and adults with growth hormone deficiency and select appropriate pharmacotherapy for these patients. 

Recombinant growth hormone therapy is the main pharmacologic treatment for growth hormone deficiency in both children and adults. 

There are two pneumococcal vaccines, a 7-valent conjugated vaccine for children younger than 6 years of age and a 23-purified-capsular polysaccharide antigen vaccine for adults. The 23 capsular types in the vaccine represent at least 85% to 90% of the serotypes that cause invasive pneumococcal infections among children and adults in the United States.41 After vaccination, an antigen-specific antibody response, indicated by a twofold or greater rise in serotype-specific antibody, develops within 2 to 3 weeks in 80% or more of healthy young adults.42... 

FIGURE 69-5. Treatment algorithm for management of pharyngitis in children and adults.45,46 aRapid antigen detection tests (RADTs) are preferred if the test sensitivity exceeds 80%. 

In both children and adults with ALL, clinical trials have identified several risk factors that correlate with outcome (Table 92-5). Prognostic features include age, WBC count, cytogenetic abnormalities, ploidy, leukemic cell immunophe-notype, and degree of initial response to therapy.7 When these factors are combined, they predict groups of patients with varying degrees of risk for treatment failure. 

The optimal duration of maintenance therapy in both children and adults is unknown, but most regimens are given for 2 to 3 years extension of the regimen beyond 3 years has not shown any additional benefit. 

In leukemia, the intensified use of methotrexate and glucocorticoids is responsible for causing an increased frequency of neurotoxicity and, in older children and adults, avascular necrosis of bone. High cumulative doses of anthracyclines can cause cardiomyopathy. Cranial irradiation causes neuropsychologic deficits and endocrine abnormalities that lead to obesity, short stature, precocious puberty, and osteoporosis.3 As newer and more intensive treatments enter clinical trials, close observation for long-term side effects will assume even greater importance.24... 

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