True Rate of Allergy among Pediatric Inpatients with Penicillin Allergy Labels (TRIAL).

Background: Penicillin allergy is a common drug allergy diagnosis in pediatric patients; however, upon appropriate allergy testing, many of these patients are found not to have a true allergy. For patients with a reported allergy, alternative antibiotics are prescribed, which are less effective, more toxic, or more expensive. There is a lack of data evaluating allergies in hospitalized children and comparing allergy assessments conducted by pediatric allergists and pharmacists.

Describing Intravenous Extravasation Injuries in Children (DIVE2 Study).

Background: Extravasation is the erroneous delivery of IV medication or fluid into the extravascular space. Complications ranging from mild injury to amputation can result, depending on the physical and pharmacologic properties of the infusate. Children are at increased risk for extravasation injuries.

Effectiveness of Alprostadil for Ductal Patency.

Objectives: This study aims to describe the effectiveness of low initial alprostadil dosages to maintain a patent ductus arteriosus (PDA) in infants with ductal-dependent congenital heart disease (DDCHD). Secondary objectives were to describe any adverse drug events, describe prescribing trends, describe ductus arteriosus diameter changes, and compare the safety and efficacy of very low and low initial alprostadil dosage regimens.

Methods: This retrospective observational cohort study at the British Columbia's Women's and Children's Hospital neonatal intensive care unit and pediatric intensive care unit examined neonates admitted with DDCHD who received alprostadil to maintain ductal patency.

Pharmacologic Management of Agitation and Aggression in a Pediatric Emergency Department - A Retrospective Cohort Study.

Background: Benzodiazepine and antipsychotic use for acute management of agitation and aggression in the pediatric emergency department (ED) setting has not been well described.

Objectives: To describe medication utilization in the management of agitation and aggression in a pediatric ED and to assess the safety of their use.

Methods: This was a retrospective observational study.

Pediatric Obesity: Pharmacokinetics and Implications for Drug Dosing.

Purpose: Clinicians are increasingly likely to have under their care obese children with diseases requiring pharmacotherapy. Optimal drug dosing for this population is unclear. Excess weight likely leads to alterations in pharmacokinetics.

A naloxone admixture to prevent opioid-induced pruritus in children: a randomized controlled trial.

Purpose: Morphine administered by continuous opioid infusion (COI) or by patient-controlled analgesia (PCA) is associated with opioid-induced pruritus (OIP). Intravenous naloxone administered separately to the morphine infusion at a dose of 0.25-1.

Stability of epinephrine at standard concentrations.

Background: To minimize medication errors, standard concentrations are recommended for medications intended for continuous infusion in pediatric patients. Premixing of epinephrine (commonly used to manage septic shock in children) would improve timeliness, safety, and cost-effectiveness. However, information about the stability of epinephrine at standard concentrations is limited.

Standard-dose versus high-dose acyclovir in children treated empirically for encephalitis: a retrospective cohort study of its use and safety.

Background: Intravenous acyclovir is the treatment of choice for herpes simplex virus encephalitis. In 2006, the American Academy of Pediatrics updated its dosing recommendations for children aged 3 months to 12 years to receive high-dose acyclovir (60 mg/kg/day). The association between acyclovir dose and toxicity is unclear.

Compatibility and stability of morphine sulphate and naloxone hydrochloride in 0.9% sodium chloride for injection.

Background: Naloxone may be administered in conjunction with morphine to reduce the risk of opioid-induced pruritis. Combining these drugs for coadministration may be beneficial, but little is known about their physical compatibility and stability in combined solutions.

Objective: To describe the physical compatibility and stability of morphine sulphate and naloxone hydrochloride (at various concentrations) in IV admixtures.

A systematic review of the pharmacokinetics of antiepileptic drugs in neonates with refractory seizures.

Background: Neonatal seizures are associated with neurological sequelae and an increased risk of epilepsy later in life. Phenobarbital and phenytoin remain the antiepileptic drugs (AEDs) most commonly used to treat neonatal seizures, despite their suboptimal effectiveness and safety. As a result, other AEDs, such as levetiracetam and topiramate, are often used in neonates with refractory seizures, despite limited data and off-label use.

Canadian survey of critical care pharmacists' views and involvement in clinical research.

Background: The involvement of Canadian critical care pharmacists in clinical research is not well documented.

Objective: To describe the clinical research experience of Canadian critical care pharmacists, describe their views about clinical research, and identify factors that facilitate their involvement in clinical research.

Methods: A cross-sectional electronic survey of Canadian critical care pharmacists was developed through an iterative process and conducted from July to October 2010.

Use of methadone for prevention of opioid withdrawal in critically ill children.

Background: Opioids are commonly administered to critically ill children for analgesia and sedation, but many patients experience opioid withdrawal upon discontinuation. The authors' institution developed a protocol for using methadone to prevent opioid withdrawal in children who have received morphine by continuous IV infusion for 5 days or longer in the pediatric intensive care unit (PICU).

Objectives: The primary objectives were to determine if opioids were tapered according to the protocol and to determine the conversion ratio for IV morphine to oral methadone that was used.

Comparison of Continuous and Intermittent IV Infusion of Vancomycin: Systematic Review.

Background: There is some evidence that administration of vancomycin by continuous infusion has pharmacokinetic and pharmacodynamic advantages over traditional intermittent dosing. Whether these advantages translate into clinical efficacy remains controversial.

Objective: To review the literature comparing continuous infusion of vancomycin and conventional intermittent IV dosing in terms of efficacy and safety.

Pharmacokinetics and drug dosing in obese children.

Objectives: To review pharmacokinetics in obese children and to provide medication dosing recommendations.

Methods: EMBASE, MEDLINE, AND INTERNATIONAL PHARMACEUTICAL ABSTRACTS DATABASES WERE SEARCHED USING THE FOLLOWING TERMS: obesity, morbid obesity, overweight, pharmacokinetics, drug, dose, kidney function test, creatinine, pediatric, and child.

Results: We identified 10 studies in which the authors examined drug dosing or pharmacokinetics for obese children.

Assessing the guidelines for potassium replacement in pediatric oncology patients receiving amphotericin B.

Objective: To examine the practice of potassium chloride (KCl) replacement in pediatric oncology patients receiving amphotericin B (amp-B).

Methods: A retrospective observational chart review was conducted of patients who received amp-B on the oncology unit between August 2000 and May 2001. A survey was distributed to pediatric oncology pharmacists at other pediatric institutions to assess KCl infusion guidelines across North America.

Complementary and alternative medicine for upper-respiratory-tract infection in children.

Purpose: Evidence on the efficacy and safety of complementary and alternative medicine (CAM) for the prevention and treatment of upper-respiratory-tract infection (URTI) in children is reviewed.

Summary: A search of the literature to June 2005 identified six clinical trials examining the use of herbal medicines and nine trials of other CAM therapies. All articles were critically evaluated for adherence to standards of efficacy and safety research.

Azithromycin for improving pulmonary function in cystic fibrosis.

Objective: To review the literature concerning the use of azithromycin in the treatment of patients with cystic fibrosis (CF).

Data Sources: A search of MEDLINE (1966-April 2004), Embase (1980-April 2004), and International Pharmaceutical Abstracts (1971-April 2004) was performed. Search terms included cystic fibrosis, macrolide, and azithromycin.

Drug disposition and therapy in adolescence: the effects of puberty.

Puberty, a part of adolescence, is a time of rapid physical, psychological, and psychosocial changes. Variability in drug absorption, distribution, metabolism and excretion occurs due to physical and hormonal changes, as well as those of body composition. Environmental factors affecting nutrition and compliance in the pubescent individual also affect success in achieving desired pharmacologic effects while minimizing toxicities.

Fluoxetine in the treatment of premenstrual dysphoric disorder.

Objective: To examine the role of fluoxetine in the treatment of premenstrual dysphoric disorder (PMDD).

Data Sources: Search strategy included MEDLINE (1966-February 2002), Embase (1988-February 2002), HealthStar (1975-December 2000), Current Contents (1996-November 2001), and Copernic (November 2001). Search terms included fluoxetine, premenstrual dysphoric disorder, PMDD, late luteal-phase dysphoric disorder, and severe premenstrual syndrome.