Immunosuppressants pediatric patients

The aminosalicylates, azathioprine, 6-MP, and infliximab are all viable options for treatment and maintenance of IBD in pediatric patients. Use of immunosuppressive therapy or infliximab may help reduce overall corticosteroid exposure. 

An order was written for 30 mg Cyclosporine (immunosuppressant) oral solution to be administered to a pediatric patient. However, for several days, the nurse administered 300 mg believing that the syringe was calibrated in mg not mL. The oral solution is available as 100 mg/mL. As the pharmacist reviewed the error, he noted that the syringes accompanying the medication were never designed for pediatrics. It is not possible to calculate any dose less than 50 mg. It is imderstandable how the nurse assumed that the 3 mark was for 30 mg since it is positioned between 2,5 and 3,5 (which are European style for the decimals 2.5 and 3.5). To harmonize products in the global market, the manufacturer chose to follow European convention for expressing numbers which uses commas and decimals in the reverse manner as in the United States. 

Children Zidovudine has been studied in HIV-infected pediatric patients over 3 months of age who had HIV-related symptoms or who were asymptomatic with abnormal laboratory values indicating significant HIV-related immunosuppression. Zidovudine also has been studied in neonates perinatally exposed to HIV. 

M. Oellerich, V.W. Armstrong, F. Streit, L. Weber, B. Tonshoff, Immunosuppressive drug monitoring of sirolimus and CsA in pediatric patients, Clin. Biochem., 37... 

Nosocomial lower respiratory tract infections (LRI) represent a significant concern to those caring for hospitalized infants and children because of both their frequency and their potential severity. Pneumonia is the second most common nosocomial infections in all patients hospitalized in the United States regardless of age (1,2). Data from the National Nosocomial Infections Surveillance (NNIS) System documents that nosocomial pneumonia is the second most frequent hospital-acquired infection in critically ill infants and children as well (2,3). Many of the significant risk factors for the development of nosocomial pneumonia previously identified in adult patients, such as severe underlying cardiopulmonary disease, immunosuppression, depressed sensorium, and prior thoracoabdominal surgery, are present in pediatric patients and place them similarly at risk for nosocomial lower respiratory tract infections. In addition, there are specific clinical situations that are unique for neonatal and pediatric patients that provide additional risks for severe nosocomial lower respiratory tract infections (Table 1). 

Kale, A.S., Ferry, G.D., Hawkins, E.R End-stage renal disease in a patient with cholesteryl ester storage disease following successful hver transplantation and cyclosporine immunosuppression. J. Pediatr. Gastroenterol. Nutrit. 1995 20 95-97... 

Younes BS, McDiarmidSV, Martin MG, Vargas JH, Goss JA, Busuttil RW, Ament ME. The effect of immunosuppression on posttransplant lymphoproliferative disease in pediatric liver transplant patients. Transplantation 2000 70(l) 94-9. 

The efficacy of tacrolimus as a primary immunosuppressant for the prophylaxis of rejection and for rescue therapy following failure of conventional cyclosporin-based rejection prophylaxis has been demonstrated in numerous clinical studies in adults and pediatrics using various types of combination therapy since 1989. Tacrolimus is now well established not only as a primary immunosuppressant in organ transplantation but also an excellent rescue agent for patients experiencing posttransplant rejection while on cyclosporin-based regimens [44]. 

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