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Pharmacy
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Pharmacy Paediatrics
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Pharmacy Paediatrics

A special issue of Pharmacy (ISSN 2226-4787).

Deadline for manuscript submissions: closed (30 November 2015) | Viewed by 39293

Special Issue Editors

Prof. Dr. Sandra Benavides

E-Mail Website
Guest Editor
Department of Pharmacy Practice, PCOM Georgia School of Pharmacy, Suwanee, GA 30024, USA
Interests: pediatric pharmacotherapy; obesity; diabetes; ambulatory care services
Special Issues, Collections and Topics in MDPI journals
Dr. Richard Parrish

E-Mail Website
Guest Editor
School of Medicine, Mercer University, Macon, GA 31207, USA
Interests: pharmacy pediatrics; perioperative care; medication management; health informatics; clinical administration
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

“The paediatric population is distinct from the adult population. The uniqueness of neonates, infants, children, and adolescents is beyond the physical and developmental distinctions. Consequently, drugs behave differently in [each of] these populations…paediatric patients are not simply “smaller adults….” – Preface to Pediatric Pharmacotherapy, 2013.

This is the preamble of a recent text outlining paediatric pharmacotherapy, the first of its kind in our discipline. But, the question is: What is the nature and scope of our discipline? What discipline? For over 35 years, a gifted clinician-scientist, Milap Nahata, has pleaded with us for answers to these questions, forwarding answers—many answers—so unique and compelling, that we could not turn our attention elsewhere for very long. Both Sandra and I know this man, foremost, as a mentor and teacher, but also as a friend and humanitarian, a real learner’s learner. I met him in 1977 after he finished his residency and fellowship in Buffalo, NY; Sandra being one of his many fellows, in 2002. She and I span the entirety of his professional life and brilliant career in service to pharmacy and to children.

There are people that know Milap Nahata and those that have yet to meet him. But, knowing him doesn’t matter to Dr. Nahata as no one is a stranger to him. His generosity and strength of spirit, especially for children’s issues and pharmacy’s role in such issues, is unmatched anywhere. This Special Issue is dedicated to him, to honour his profound influence on the lives of children worldwide, as well as the kindness and patience he showed his mentees, Sandra and I.

We are very grateful to have been chosen to edit this Special Issue devoted to the pharmacotherapy and medication management of children. Together as editors, with the contribution of other authors devoted to improving care for children, we will bring new ideas for your consideration, questioning even some practices we perform as paediatrically-inclined pharmacotherapists.

We hope that you will enjoy, and learn, from this Special Issue, Pharmacy Paediatrics.

Dr. Sandra Benavides Caballero
Dr. Richard Parrish
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pharmacotheraputics
  • medication safety
  • clinical pharmacy
  • extemporaneous formulations
  • pharmacokinetics
  • pharmacogenomics
  • health promotion
  • medication adherence

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Published Papers (7 papers)

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435 KiB  
Article
Use of Etomidate for Rapid Sequence Intubation (RSI) in Pediatric Trauma Patients: An Exploratory National Survey
by Jeffrey J. Cies, Matthew L. Moront, Wayne S. Moore II, Renata Ostrowicki, Kelsey B. Gannon, Shonola S. Da-Silva, Arun Chopra and Jason Parker
Pharmacy 2015, 3(4), 197-209; https://doi.org/10.3390/pharmacy3040197 - 19 Oct 2015
Cited by 2 | Viewed by 4737
Abstract
Objective, To survey the pediatric trauma programs to ascertain if and how etomidate is being used for rapid sequence intubation (RSI) in pediatric trauma patients. Design, A 25 question survey was created using REDCaps. A link to the survey was emailed [...] Read more.
Objective, To survey the pediatric trauma programs to ascertain if and how etomidate is being used for rapid sequence intubation (RSI) in pediatric trauma patients. Design, A 25 question survey was created using REDCaps. A link to the survey was emailed to each of the pediatric and adult trauma programs that care for pediatric patients. Setting, Pediatric trauma programs and adult trauma programs caring for pediatric patients. Intervention, None. Measurements and Main Results, A total of 16% of programs responded (40/247). The majority of the centers that responded are urban, academic, teaching Level 1 pediatric trauma centers that provide care for > 200 pediatric trauma patients annually. The trauma program directors were the most likely to respond to the survey (18/40). 33/38 respondents state they use etomidate in their RSI protocol but it is not used in all pediatric trauma patients. 26/38 respondents believe that etomidate is associated with adrenal suppression and 24/37 believe it exacerbates adrenal suppression in pediatric trauma patients yet 28 of 37 respondents do not believe it is clinically relevant. Conclusions, Based on the results of the survey, the use of etomidate in pediatric trauma patients is common among urban, academic, teaching, level 1 pediatric trauma centers. A prospective evaluation of etomidate use for RSI in pediatric trauma patients to evaluate is potential effects on adrenal suppression and hemodynamics is warranted. Full article
(This article belongs to the Special Issue Pharmacy Paediatrics)
217 KiB  
Article
Antimicrobial Renal Injury in a Pediatric Intensive Care Unit: β-Lactams vs. Vancomycin
by Jeffrey J. Cies, Wayne S. Moore II, Venkat Shankar and Arun Chopra
Pharmacy 2014, 2(4), 276-286; https://doi.org/10.3390/pharmacy2040276 - 28 Nov 2014
Cited by 3 | Viewed by 5237
Abstract
Vancomycin trough (Vt) concentrations of 15–20 mcg/mL have been associated with an increased rate of renal injury in adults. Current data in pediatrics suggests Vts of 15–20 mcg/mL do not increase the risk of renal injury in children admitted to a pediatric intensive [...] Read more.
Vancomycin trough (Vt) concentrations of 15–20 mcg/mL have been associated with an increased rate of renal injury in adults. Current data in pediatrics suggests Vts of 15–20 mcg/mL do not increase the risk of renal injury in children admitted to a pediatric intensive care unit (PICU). The primary objective was to determine if a difference exists in the incidence of renal injury in PICU patients receiving a β-lactam as compared with vancomycin therapy with Vts of 15–20 mcg/mL. This was a retrospective cohort study conducted within a PICU within a freestanding tertiary care pediatric hospital. The records of children admitted to the PICU between 10/2008–6/2009 who received vancomycin for ≥48 h targeting higher Vt concentrations of ≥15 mcg/mL for pneumonia, bacteremia, and meningitis were reviewed. This cohort (V group) was compared to children admitted from July 2009–July 2013 who received cefepime or piperacillin/tazobactam for ≥72 h (B group). Serum creatinine values were collected from 48 h before until 48 h after discontinuation of therapy for calculation of estimated glomerular filtration rate. Renal injury was categorized according to pRIFLE. 57 and 112 patients were included in the V and B groups, respectively. The mean (SD) therapeutic dose of vancomycin was 63.5(17.3) mg/kg/day and the mean (SD) trough was 17.8(3.1). The mean (SD) dose of cefepime was 51(26) mg/kg/dose with an every 8 h interval. The mean (SD) dose of piperacillin/tazobactam was 77(22) mg/kg/dose with an every 6 h interval. The mean (SD) PRISM scores were 10.9(10.2), 4.24(6.4) for the V and B groups, respectively (p < 0.001). Five of 57 and 10 of 112 patients in the V and B groups, respectively, were classified as having injury according to pRIFLE. No patient was classified as having a degree of renal injury greater than the pRIFLE injury. The incidence of renal injury was 8.8% in the V group and 8.9% in the B group, respectively (p = 1). Our observations suggest that maintaining Vt concentrations ≥15 mcg/mL is not associated with an increased rate of renal injury as compared with β-lactam monotherapy in a PICU population. Full article
(This article belongs to the Special Issue Pharmacy Paediatrics)

Other

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180 KiB  
Concept Paper
Establishment of Pediatric Medication Therapy Management: A Proposed Model
by Sandra Benavides, Shirin Madzhidova, Anihara Hernandez, Thao Le, Stephanie M. Palma and Steffi Stephen
Pharmacy 2016, 4(1), 5; https://doi.org/10.3390/pharmacy4010005 - 19 Jan 2016
Cited by 10 | Viewed by 5075
Abstract
Ongoing healthcare reform calls for increased accessibility, enhanced delivery, and improved quality of healthcare. Children and adolescents are experiencing a rise in the prevalence in chronic diseases leading to an increased utilization of medications. The increased use of chronic medications can lead to [...] Read more.
Ongoing healthcare reform calls for increased accessibility, enhanced delivery, and improved quality of healthcare. Children and adolescents are experiencing a rise in the prevalence in chronic diseases leading to an increased utilization of medications. The increased use of chronic medications can lead to more medication errors or adverse drug events, particularly in children and adolescents using multiple chronic medications. These ongoing changes expand opportunities for a pharmacist to become further integrated in the inter-professional healthcare delivery for pediatric patients, particularly in an ambulatory or community setting. To date, a systemic process for the provision of medication therapy management (MTM) services in pediatric patients has not been elucidated. The purpose of this paper is to describe a proposed model for delivering pediatric MTM. Furthermore, based on the available literature related to pediatric patients at risk for medication errors, adverse drug reactions, and subsequently-increased utilization of emergency departments and hospitalizations, a set of criteria is proposed for further research investigation. Full article
(This article belongs to the Special Issue Pharmacy Paediatrics)
934 KiB  
Concept Paper
Positioning a Paediatric Compounded Non-Sterile Product Electronic Repository (pCNPeRx) within the Health Information Technology Infrastructure
by Richard H. Parrish, II
Pharmacy 2016, 4(1), 2; https://doi.org/10.3390/pharmacy4010002 - 24 Dec 2015
Cited by 4 | Viewed by 5461
Abstract
Numerous gaps in the current medication use system impede complete transmission of electronically identifiable and standardized extemporaneous formulations as well as a uniform approach to medication therapy management (MTM) for paediatric patients. The Pharmacy Health Information Technology Collaborative (Pharmacy HIT) identified six components [...] Read more.
Numerous gaps in the current medication use system impede complete transmission of electronically identifiable and standardized extemporaneous formulations as well as a uniform approach to medication therapy management (MTM) for paediatric patients. The Pharmacy Health Information Technology Collaborative (Pharmacy HIT) identified six components that may have direct importance for pharmacy related to medication use in children. This paper will discuss key positions within the information technology infrastructure (HIT) where an electronic repository for the medication management of paediatric patients’ compounded non-sterile products (pCNP) and care provision could be housed optimally to facilitate and maintain transmission of e-prescriptions (eRx) from initiation to fulfillment. Further, the paper will propose key placement requirements to provide for maximal interoperability of electronic medication management systems to minimize disruptions across the continuum of care. Full article
(This article belongs to the Special Issue Pharmacy Paediatrics)
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512 KiB  
Concept Paper
An Algorithm to Identify Compounded Non-Sterile Products that Can Be Formulated on a Commercial Scale or Imported to Promote Safer Medication Use in Children
by Varsha Bhatt-Mehta, Robert B. MacArthur, Raimar Löbenberg, Jeffrey J. Cies, Ibolja Cernak and Richard H. Parrish II
Pharmacy 2015, 3(4), 284-294; https://doi.org/10.3390/pharmacy3040284 - 11 Nov 2015
Cited by 5 | Viewed by 5524
Abstract
The lack of commercially-available pediatric drug products and dosage forms is well-known. A group of clinicians and scientists with a common interest in pediatric drug development and medicines-use systems developed a practical framework for identifying a list of active pharmaceutical ingredients (APIs) with [...] Read more.
The lack of commercially-available pediatric drug products and dosage forms is well-known. A group of clinicians and scientists with a common interest in pediatric drug development and medicines-use systems developed a practical framework for identifying a list of active pharmaceutical ingredients (APIs) with the greatest market potential for development to use in pediatric patients. Reliable and reproducible evidence-based drug formulations designed for use in pediatric patients are needed vitally, otherwise safe and consistent clinical practices and outcomes assessments will continue to be difficult to ascertain. Identification of a prioritized list of candidate APIs for oral formulation using the described algorithm provides a broader integrated clinical, scientific, regulatory, and market basis to allow for more reliable dosage forms and safer, effective medicines use in children of all ages. Group members derived a list of candidate API molecules by factoring in a number of pharmacotherapeutic, scientific, manufacturing, and regulatory variables into the selection algorithm that were absent in other rubrics. These additions will assist in identifying and categorizing prime API candidates suitable for oral formulation development. Moreover, the developed algorithm aids in prioritizing useful APIs with finished oral liquid dosage forms available from other countries with direct importation opportunities to North America and beyond. Full article
(This article belongs to the Special Issue Pharmacy Paediatrics)
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345 KiB  
Opinion
Creating a Distinct Medication-Use System for Children at the Point of Care: The Time is Now
by Richard Parrish II and Ibolja Cernak
Pharmacy 2015, 3(3), 72-78; https://doi.org/10.3390/pharmacy3030072 - 25 Jun 2015
Cited by 5 | Viewed by 4894
Abstract
Children need a distinct medicines-use system designed explicitly for them since their continued inclusion in a system of prescription processing developed for adults generates insoluble risk points and workarounds. The American Academy of Pediatrics (AAP), in its policy statement released by the AAP [...] Read more.
Children need a distinct medicines-use system designed explicitly for them since their continued inclusion in a system of prescription processing developed for adults generates insoluble risk points and workarounds. The American Academy of Pediatrics (AAP), in its policy statement released by the AAP Committee on Drugs in early 2014 about off-label use in children, posits that federal legislation on increased drug testing in children has been effective, as “there have been over 500 pediatric-specific labeling changes.” However, the AAP’s position has not changed materially since the original 2002 policy statement. Indeed, other health professionals, their organizations, or affiliated practice-based research network (PBRNs) mechanisms continue to be excluded from consideration, collaboration, or even honorable mention. It is noteworthy that most of the 500 labeling changes made since 1997 have addressed the scientific validity of indications for medication use in pediatric population without regard to pharmacotherapy formulation or monitoring. Medication use in children continues to be associated with an unacceptably high rate of adverse events, morbidity, and death. Children should no longer be “shoehorned” into the adult medication-use system, which faces challenges in addressing even the adult population’s needs. The time is now to design a multi-phasic, systematic approach to the pharmacotherapy of children. This paper will argue for the establishment of a distinct medication use system for children, a trans-disciplinary system designed thoughtfully and intentionally, not by convention, consensus, or imitation. Full article
(This article belongs to the Special Issue Pharmacy Paediatrics)
173 KiB  
Concept Paper
Optimizing Effectiveness in Electronic Prescriptions for Pediatric Outpatients: A Call for Responsive Action
by Richard H. Parrish II, Sandra Benavides, Joseph T. Malak, Amy L. Potts, Micheal Guirguis and Tracy Hagemann
Pharmacy 2014, 2(4), 260-269; https://doi.org/10.3390/pharmacy2040260 - 30 Sep 2014
Cited by 3 | Viewed by 6865
Abstract
A pediatric compounded non-sterile products repository (pCNP) to optimize the effectiveness and safety of “off-label” use of compounded pharmacotherapy through complete transmission of electronic prescriptions across the continuum of care is described. The advent of electronic prescribing has the potential to refocus and [...] Read more.
A pediatric compounded non-sterile products repository (pCNP) to optimize the effectiveness and safety of “off-label” use of compounded pharmacotherapy through complete transmission of electronic prescriptions across the continuum of care is described. The advent of electronic prescribing has the potential to refocus and resolve long-standing issues of prescription therapy for pediatric patients related to formulation, indication, dosing, and outcomes follow-up, among others. This white paper describes the architecture and function of the pCNP repository. Further, it calls on professional societies, health information technology (HIT) and pharmaceutical industries, universities, and government to create a safer pediatric pharmacotherapy system across the continuum of care. This system would include pCNPs within the existing federal and corporate database structures for medical language, and integrates advanced system safety features as requirements for prescribing, compounding, and dispensing non-mass produced prescription therapies for children. Full article
(This article belongs to the Special Issue Pharmacy Paediatrics)
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