Pediatric patients

One of the oldest antiepileptic drugs, bromide, has been repotted to boost inhibition by an unknown mechanism. Bromide is still in use in certain cases of tonic-clonic seizures and in pediatric patients with recurrent febrile convulsions and others. The mechanism of action may include a potentiation of GABAergic synaptic transmission, although the precise target is not known. 

Sevoflurane (Ultane) is an inhalational analgesic. It is used for induction and maintenance of general anesthesia in adult and pediatric patients for inpatient and outpatient surgical procedures. 

Masseter muscle spasm, which sometimes is a warning sign of MH, was found in 1 12,000 anesthetics. However, masseter muscle spasm is not diagnostic of an impending MH crisis. Even though approximately 50% of patients with masseter muscle spasm have tested positive for MH by muscle biopsy, this does not reflect the true incidence of MH. Incidence of masseter spasm is reported to be as high as 1% in pediatric patients, yet MH occurs in only about one in 15,000 pediatric patients. 

Arnold JH, Truog RD, Rice SA Prolonged administration of isoflurane to pediatric patients during mechanical ventilation. Anesth Analg 76 520—526, 1993... 

DeVincenzo et al. 2008). Phase n clinical trials in naturally infected RSV patients were initiated in April 2008. ALN-RSVOl is expected to advance into the pediatric patient population by the second half of 2008. 

Kiratiseavee S, Ranesg S Evaluation of pediatric patients admitted with adverse food reactions to an inner-city pediatric ED. J Allergy Chn Immunol 2007 119 S114. 

De Swert LF, Bullens D, Raes M. Dermaux AM Anaphylaxis in referred pediatric patients demographic and chnical features, triggers, and therapeutic approach. Eur J Pediatr 2008 167 1251-1261. Brockow K, Jofer C, Behrendt H, Ring J Anaphylaxis in patients with mastocytosis a study on history chnical features and risk factors in 120 patients. AUergy 2008 63 226-232. 

Lopez R, et al Prevalence of allergy and anaphylac- 18 tic symptoms in 210 adult and pediatric patients with mastocytosis in Spain a study of the Spanish Network on Mastocytosis (REMA). Chn Exp Allergy 2007 37 1547-1555. lO... 

VTE in pediatric patients. Children less than 1 year old require higher doses (e.g., enoxaparin 1.5 mg/kg SC every 12 hours). Monitor anti-factor Xa activity to guide dosing in children.32... 

Fondaparinux is pregnancy category B, but there are very limited data regarding its use during pregnancy. Use in pediatric patients has not been studied.29,38,39... 

The addition of ipratropium bromide to inhaled p2-agonist therapy in acute severe asthma improves pulmonary function and decreases hospitalization rates in both adult and pediatric patients.31 The benefit of combining ipratropium and albuterol appears to be greatest in moderate to severe exacerbations, and the combination should be considered first-line therapy in severe exacerbations. 

Comparable daily doses of PPIs are omeprazole 20 mg = esomeprazole 20 mg = lansoprazole 30 mg = rabeprazole 20 mg = pantoprazole 40 mg. The PPIs degrade in acidic environments and are therefore formulated in delayed-release capsules or tablets.16 Lansoprazole, esomeprazole, and omeprazole contain enteric-coated (pH-sensitive) granules in a capsule form. For patients unable to swallow the capsule or in pediatric patients, the contents of the capsule can be mixed in applesauce or placed in orange juice. If a patient has a nasogastric tube, the contents of an omeprazole capsule can be... 

The combination of a prokinetic agent and acid-suppressing drug is used commonly in pediatric patients with GERD.27 Monotherapy with an H2RA is also used frequently ranitidine 2 to 4 mg/kg/day is effective in neonates and pediatric patients. 

CD occurs in approximately 4.56 per 100,000 pediatric patients, and UC occurs in about 2.14 cases per 100,000.43 A major issue in children with IBD is the risk of growth failure secondary to inadequate nutritional intake. Failure to thrive may be an initial presentation of IBD in this population. Aggressive nutritional interventions may be required to facilitate adequate caloric intake. Chronic corticosteroid therapy may also be associated with reductions in growth. 

Pediatric patients are also at higher risk for IBD-associated bone demineralization, which is accelerated by the use of systemic corticosteroids. 

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. 

American Society of Health-System Pharmacists. ASHP therapeutic guidelines on the pharmacologic management of nausea and vomiting in adult and pediatric patients receiving chemotherapy or radiation therapy or undergoing surgery. Am J Health-Syst Pharm 1999 56 729-764. 

Pediatric patients should be observed closely for suicidality, worsened depression, agitation, irritability, and unusual changes in behavior, especially during the initial few months of therapy or at times of dosage changes. Furthermore, families and caregivers should be advised to monitor patients for such symptoms. 

Antidepressant medications appear to be useful for certain children and adolescents, particularly those who have severe or psychotic depression, fail psychotherapeutic measures, or experience chronic or recurrent depression. SSRIs generally are considered the initial antidepressants of choice, although comorbid conditions may favor alternative agents. Clinicians should be aware of the possibility of behavioral activation with the SSRIs, including such symptoms as impulsivity, silliness, daring conduct, and agitation.44 Desipramine should be used with caution in this population because of several reports of sudden death, and a baseline and follow-up electrocardiogram (ECG) may be warranted when this medication is used to treat pediatric patients.9... 

The FDA is in the process of analyzing data to determine whether there is an increased risk of suicidality in adult patients similar to that seen in pediatric patients (see above). Even though the suicidality risk for adults taking antidepressant medications... 

Recommend treatment approaches for special populations of patients with bipolar disorder, including pediatric patients, geriatric patients, and pregnant patients. 

Intranasal corticosteroids are the most effective anti-inflammatory agents used in pediatric patients with allergic rhinitis. Although fewer studies have been conducted in children, results demonstrate that intranasal corticosteroids are effective and well tolerated, with an adverse-effect profile similar to placebo. Mometasone is indicated for children as young as 2 years of age, fluticasone is indicated for children 4 years of age and older, and beclomethasone, budesonide, flunisolide, and triamcinolone are indicated for children 6 years and older.15 Because concerns regarding effect of intranasal steroids on growth exist, the growth of pediatric patients prescribed intranasal steroids should be monitored routinely via stadiometry. 

Primary indication stroke prevention in pediatric patients... 

Prior to the introduction of the Hib conjugate vaccine, H. influenzae type b was the most common cause of bacterial meningitis in the United States.5 Routine inoculation of pediatric patients against Hib since 1991 has reduced the incidence of invasive Hib disease (i.e., meningitis and sepsis) in children younger than 5 years of age by 99%,6 with mortality from Hib... 

Design, evaluate, and assess an appropriate therapeutic plan for an immunocompetent, immunocompromised, pregnant, and pediatric patient. 

O All symptomatic adults and children over the age of 8 years should be treated with metronidazole 250 mg three times daily for 7 days, or tinidazole 2 gas a single dose, or nitazoxanide 500 mg twice daily for 3 days.3 The pediatric dose of metronidazole is 15 mg/kg per day three times daily far 7 days. Alternative drugs include furazolidone 100 mg four times daily or paromomycin 25 to 30 mg/kg per day in divided doses daily for 7 days. Paromomycin may be used in pregnancy instead of metronidazole. Pediatric patients can also be treated with suspensions of either furazolidone 8 mg/kg per day in four divided doses far 7 days, or nitazoxanide (Alina) 100 to 200 mg every 12 hours for 3 days. 

Quinacrine 100 mg three times in adults or 5 mg/kg per day in pediatric patients for 5 to 7 days, is available from a specialized pharmacy (e.g., Ponorama Compounding Pharmacy).3... 

In both adults and pediatric patients older than 2 years of age, mebendazole 100 mg twice daily for 3 days is the treatment to use. An alternative agent is pyrantel pamoate (Antiminth). The stool should be checked within 2 weeks and the patient retreated when warranted. 

Tapeworm infections (T. saginata and T. solium) are treated with praziquantel 5 to 10 mg/kg as a single dose (use the same dose for adults and pediatric patients).3 The treatment for cysticercosis and neurocysticercosis may include surgery, anticonvulsants (neurocysticercosis can cause seizures), and anthelmintic therapy. The anthelmintic therapy of choice is albendazole 400 mg twice daily for 8 to 30 days. The pediatric dose of albendazole is 15 mg/kg (maximum 800 mg) in two divided doses for 8 to 30 days. The doses for both adults and pediatric subjects can be repeated if necessary. Praziquantel is an alternative therapy.3... 

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