Parenteral Beta-Lactam/Beta-Lactamase Inhibitor Ordering in Hospitals That Provide Care for Pediatric Patients.

Objectives: The purpose of this study was to define current practices related to beta-lactam/beta-lactamase inhibitor (BL/BLI) dose descriptions in hospitals that provide care for pediatric patients and to identify perceived implications of standardizing BL/BLI dose communication and ordering to a total drug-based strategy.

Methods: A 27-item electronic survey was distributed via 4 pediatric pharmacy and infectious diseases listservs. Survey questions pertained to hospital demographics, dosing communication practices, BL/BLI ordering and labeling practices, obstacles to safe BL/BLI use, and the effects of potential standardization to a total drug communication strategy.

Measurement of Polyethylene Glycol 3350 With Standard Household Measuring Devices.

Objective: Though standard household measuring devices (e.g., teaspoons, tablespoons) are often used in clinical practice to measure pediatric doses of polyethylene glycol 3350 (PEG-3350), no published -literature documents the accuracy of these measurements.

National Amoxicillin-Clavulanate Formulation Use Pattern: A Survey.

Objective: Five commercially available amoxicillin-clavulanate (AMC) ratio formulations contribute to ratio selection variability with efficacy and toxicity implications. The objective of this survey was to determine AMC formulation use patterns across the United States.

Methods: A multicenter practitioner survey was distributed to multiple listservs (American College of Clinical Pharmacy pediatrics, infectious diseases, ambulatory care, pharmacy administration; American Society of Health-System Pharmacists; Pediatric Pharmacy Association members), and selected pediatric Vizient members in June 2019.

Implementation of a Shared Pediatric Pharmacy Elective During the COVID-19 Pandemic.

During the COVID-19 pandemic, educators were forced to identify innovative teaching strategies to deliver high-quality learning experiences to students. In spring 2021, faculty at Butler College of Pharmacy and Health Sciences and Purdue University College of Pharmacy collaborated to successfully implement a shared pediatric pharmacy elective at both institutions.

Joint Statement on Pediatric Education at Schools of Pharmacy.

Providing health care for children is a unique specialty, and pediatric patients represent approximately 25% of the population. Education of pharmacy students on patients across the lifespan is required by current Accreditation Council for Pharmacy Education standards and outcomes; thus, it is essential that pharmacy students gain a proficiency in caring for children. A collaborative panel of pediatric faculty members from schools and colleges of pharmacy was established to review the current literature regarding pediatric education in Doctor of Pharmacy curricula and establish updated recommendations for the provision of pediatric pharmacy education.

Assessment of Pharyngitis Management at a University Student Health Services Clinic.

Objective: The objective of this study was to assess the management of students presenting with pharyngitis to a university health clinic.

Methods: This was a retrospective cohort study. Electronic medical records of undergraduate students presenting to a university health clinic from January 1, 2012, through December 31, 2014, with complaints of sore throat and a diagnosis code for pharyngitis, tonsillitis, or sore throat were reviewed.

Comparison of Antibiotic Dosing Before and After Implementation of an Electronic Order Set.

Background: To maximize resources, the antimicrobial stewardship program at a pediatric tertiary care hospital made pediatric dosing specific guidance within the electronic health record available to all hospitals within the health system.

Objective: The objective of this study was to compare the appropriateness of antibiotic dosing before and after the implementation of an electronic intravenous (IV) antibiotic order set.

Methods: This was a retrospective cohort study evaluating orders from patients younger than 18 years who received cefepime, piperacillin-tazobactam, tobramycin, or gentamicin at 12 health-system hospitals.

Identification of Factors Associated With the Desire to Participate in a Pediatric Pharmacy Practice-Based Research Network.

Objectives: To evaluate the practice-based research network (PBRN) potential within the Pediatric Pharmacy Advocacy Group (PPAG) membership and to identify characteristics associated with member willingness to join a PPAG PBRN.

Methods: In October 2016, a 21-question survey was sent by email to approximately 900 PPAG pharmacist members (excluding students) using contact information contained in the PPAG membership database. The survey elucidated information regarding training, clinical and research experience, practice site information, and willingness to participate in a PPAG PBRN.

Characterization of the Clinical Outcomes With Cefepime in a Neonatal Intensive Care Unit: A Retrospective Cohort Study.

Objectives: The objective of this study was to characterize clinical outcomes when cefepime was used in a neonatal intensive care population.

Methods: Data were extracted from the medical records of all full-term (40 weeks gestational age) patients up to 2 months of age and preterm patients up to 48 weeks postmenstrual age admitted to the neonatal intensive care unit (NICU) at a freestanding children's hospital between January 1, 2010, and December 31, 2013, who received at least 48 hours of cefepime. The primary outcome measure was a positive clinical response as defined by a normalization of white blood cell count and/or culture clearance.

Clinical Outcomes With Continuous Nafcillin Infusions in Children.

Objectives: The primary objective of this study was to describe the clinical outcomes of continuous nafcillin infusion in pediatric patients.

Methods: This was a retrospective case study performed at a freestanding, tertiary care children's hospital. Subjects were included if they were at least 30 days old and had received more than 1 dose of nafcillin by continuous infusion (CI) between January 1, 2009, and December 31, 2012.

Population Pharmacokinetics and Pharmacodynamic Target Attainment of Vancomycin in Neonates on Extracorporeal Life Support.

Objectives: To evaluate the population pharmacokinetics and pharmacodynamic target attainment of vancomycin in neonates with a contemporary ¼-inch extracorporeal life support circuit with a Quadrox-iD Pediatric oxygenator (Maquet Cardiovascular, LLC, Wayne, NJ).

Design: Retrospective medical record review.

Setting: Two free-standing tertiary/quaternary pediatric children's hospitals.

Extended Infusion of Piperacillin/Tazobactam in Children.

Objectives: Extended-infusion piperacillin/tazobactam (TZP) has been associated with positive clinical outcomes in adults, but similar data in children are lacking. The objective of this study was to describe efficacy outcomes with pediatric patients receiving extended-infusion TZP.

Methods: This was a retrospective case series of children aged 1 month to 17 years who had documented Gram-negative infection and received extended-infusion TZP between April 2011 and March 2012.

Evaluation of an Unfractionated Heparin Pharmacy Dosing Protocol for the Treatment of Venous Thromboembolism in Nonobese, Obese, and Severely Obese Patients.

Background: Despite large interpatient variability in dose response, heparin is utilized for treatment of venous thromboembolism (VTE). Current data on the optimal heparin dosing in obese patients are conflicting.

Objective: The objective was to evaluate the time and dose required to achieve a therapeutic activated partial thromboplastin time (aPTT) in nonobese, obese, and severely obese patients using a pharmacist-directed heparin dosing protocol.

Occurrence of Potential Adverse Drug Events from Prescribing Errors in a Pediatric Intensive and High Dependency Unit in Hong Kong: An Observational Study.

Background: Critically ill pediatric patients are considered at high risk for medication errors. Although much research focuses on the actual errors, equally important are medication errors that, although intercepted, carried the potential for an adverse drug event. The aim of this study was to determine the occurrence of prescribing errors and potential adverse drug events (pADEs) in a local pediatric intensive and critical care unit (PICU) in Hong Kong.

Optimizing Guideline-Recommended Antibiotic Doses for Pediatric Infective Endocarditis.

The American Heart Association recently published an updated scientific statement on the management of infective endocarditis in childhood. The recommendations included for vancomycin, aminoglycoside, and β-lactam dosing and monitoring are based primarily on expert opinion and do not consider available evidence for dose optimization based on pharmacokinetic and pharmacodynamic principles in pediatric patients. This is concerning because even when clinically necessary, some practitioners may be hesitant to deviate from guideline-recommended doses.

Compatibility of Vancomycin and Oxacillin During Simulated Y-Site Delivery.

Background: Vancomycin and oxacillin may be used together as empiric coverage in patients with proven or suspected Staphylococcus aureus infections. Though vancomycin hydrochloride 20 mg/mL and oxacillin sodium 160 mg/mL are reported to be compatible via Y-site delivery, Y-site compatibility of commonly used concentrations, vancomycin 10 mg/mL and oxacillin 20 mg/mL, has not yet been reported.

Objective: To determine the Y-site compatibility of vancomycin 10 mg/mL and oxacillin 20 mg/mL.

Population Pharmacokinetics and Pharmacodynamics of Extended-Infusion Piperacillin and Tazobactam in Critically Ill Children.

The study objective was to evaluate the population pharmacokinetics and pharmacodynamics of extended-infusion piperacillin-tazobactam in children hospitalized in an intensive care unit. Seventy-two serum samples were collected at steady state from 12 patients who received piperacillin-tazobactam at 100/12.5 mg/kg of body weight every 8 h infused over 4 h.

Linezolid-Associated Thrombocytopenia in Children With Renal Impairment.

Impaired renal function has been associated with an increased risk of thrombocytopenia in adults receiving linezolid. Findings from this retrospective cohort demonstrate an association between thrombocytopenia and lower creatinine clearance in children receiving linezolid.

Late-Occurring Vancomycin-Associated Acute Kidney Injury in Children Receiving Prolonged Therapy.

Background: Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy.

Methods: Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included.

Success With Extended-Infusion Meropenem After Recurrence of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis in an Adolescent.

A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC).

Acid-Suppressing Agents and Risk for Clostridium difficile Infection in Pediatric Patients.

Background: Acid-suppressing agents have been associated with increased Clostridium difficile infection (CDI) in adults. The objective of this study was to evaluate the association of acid-suppressing therapy with the development of CDI in the pediatric population.

Methods: This was a retrospective case-control study.

Implementing extended-infusion cefepime as standard of care in a children's hospital: a prospective descriptive study.

Background: Extended-infusion cefepime (EIC) has been associated with decreased mortality in adults, but to our knowledge, there are no studies in children.

Objective: The objective of this study was to determine the feasibility of implementing EIC as the standard dosing strategy in a pediatric population.

Methods: This was a descriptive study of children aged 1 month to 17 years, including patients in the intensive care unit, who received cefepime after admission to a freestanding, tertiary care children's hospital.

Optimized antimicrobial dosing strategies: a survey of pediatric hospitals.

Background: Extended-interval aminoglycoside (EIAG) and extended- and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited.

Objective: The objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA.

Study Design, Setting, And Participants: A national survey of children's hospitals was conducted.

Cinacalcet administration by gastrostomy tube in a child receiving peritoneal dialysis.

A 2-year-old male with chronic kidney disease with secondary hyperparathyroidism developed hypercalcemia while receiving calcitriol, without achieving a serum parathyroid hormone concentration within the goal range. Cinacalcet 15 mg (1.2 mg/kg), crushed and administered via gastrostomy tube, was added to the patient's therapy.

Are Elevated Vancomycin Serum Trough Concentrations Achieved Within the First 7 Days of Therapy Associated With Acute Kidney Injury in Children?

Background: In 2008, the empiric vancomycin dosing recommendation in children at our institution was changed from 40 to 60 mg/kg per day. Subsequently, an increased incidence of acute kidney injury (AKI) in patients receiving vancomycin was suspected. The objective of this study was to evaluate AKI in children receiving vancomycin and to determine risk factors for AKI development.