Challenges in providing pharmaceutical care to pediatric patients

Zenk, Karin E.

doi:10.1093/ajhp/51.5.688

Cited by 6 publications

(10 citation statements)

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“…Over the past few decades, the importance of applying pharmacokinetic principles to the design of drug regimens has been increasingly recognised by clinicians (Li et al 1999). This is especially true in neonatology, where patients are at risk because of the lack of knowledge about their special needs, lack of clinical data for them, insuf®cient drug labelling, and limited dosage forms (Zenk 1994).…”

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confidence: 99%

The Kinetic Profile of Gentamicin in Premature Neonates

Rocha

Almeida

Afonso

et al. 2000

Journal of Pharmacy and Pharmacology

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The kinetic profile of gentamicin in premature infants has been studied to enable the development of optimized dosage schedules for neonatal intensive-care units and to stress the relationship between the pharmacokinetic parameters and several demographic, developmental and clinical factors which might be associated with changes in gentamicin disposition. Sixty-eight newborn patients of 24- to 34-weeks gestational age and 600-3,100 g current weight in their first week of life, undergoing routine therapeutic drug monitoring of their gentamicin serum levels, were included in this retrospective analysis. Gentamicin pharmacokinetic parameters were determined through non-linear regression by using a single-compartment open model. By regression analysis the current weight (g) was shown to be the strongest co-variate, and both gentamicin clearance (L h(-1)) and volume of distribution (L) had to be normalized. Additionally, gentamicin clearance depended on gestational age with a cut-off at 30 weeks, which allowed the division of the overall population into two subsets (< 30 weeks and between 30-34 weeks of gestational age). The younger neonates (<30 weeks of gestational age) showed a lower gentamicin clearance (0.0288 vs 0.0340 L h(-1) kg(-1)), a slightly higher volume of distribution (0.464 vs 0.435 L kg(-1)), and a longer half-life (11.17 vs 8.88 h) compared with the older subgroup (30-34 weeks of gestational age). On the basis of the pharmacokinetic parameters obtained, we suggest loading doses of 3.7 and 3.5 mg kg(-1) for the two subgroups of neonates (<30 weeks and 30-34 weeks of gestational age), respectively. The appropriate maintenance doses in accordance with the characteristics of the patients should be 2.8 mgkg(-1)/24h and 2.6 mg kg(-1)/18 h for neonates < 30 weeks and between 30-34 weeks of gestational age, respectively. Finally, when compared with previous studies, the information obtained on the pharmacokinetics and determinants of the pharmacokinetic variability of gentamicin in neonates was shown to be consistent.

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confidence: 99%

The Kinetic Profile of Gentamicin in Premature Neonates

Rocha

Almeida

Afonso

et al. 2000

Journal of Pharmacy and Pharmacology

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“…The case study described above depicts Gray Baby Syndrome, a phenomenon noted four decades ago when chloramphenicol was administered to term and pre-term infants in doses deemed safe for older infants and children (Zenk, 1994). Later, it was noted that neonates and pre-term infants had a reduced capacity for glucuronidation of chloramphenicol.…”

Section: What Is the Diagnosis?mentioning

confidence: 99%

“…At birth, the gastric pH is neutral or alkaline, but then falls to 1.5-3.0 (Reed, 1996;Sagraves, 1995). During the first 10-30 days after birth, a relative achlorhydria (increased gastric pH) occurs; this can cause some drugs (e.g., phenobarbital) that need an acidic medium to become less effective (Reed, 1996;Sagraves, 1995;Zenk, 1994). Conversely, some basic drugs (e.g., diazepam, theophylline) may have an enhanced absorption (Blaho,Winbery, & Merigion, 1996;Reed, 1996).…”

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confidence: 99%

Pharmacokinetics in Children: History, Considerations, and Applications

Suggs

2000

Journal of the American Academy of Nurse Practitioners

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“…The subsequent lack of formally circulated, well-researched drug information, and provision of adult-sized drug vials only, come as a direct consequence of this and are important factors in errors. [28] Gilman and Gal [29] report that drugs are more likely to have dosage information for older children than for those less than 1 month of age. Prescription drugs listed in the 1991 Physician's Desk Reference were not approved for use in children in 62% of cases.…”

Section: Therapeutic Orphansmentioning

confidence: 99%

“…Bedside technology is available that can remind the nurse when a dose is due and check drug type using a barcode system. [28,92] Most important of all is the fostering of a nonpunitive approach to the reporting of error. [2] …”

Section: The Commonest Errormentioning

confidence: 99%

Common Errors of Drug Administration in Infants

Anderson¹,

Ellis²

1999

Pediatric Drugs

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Drug administration errors are common in infants. Although the infant population has a high exposure to drugs, there are few data concerning pharmacokinetics or pharmacodynamics, or the influence of paediatric diseases on these processes. Children remain therapeutic orphans. Formulations are often suitable only for adults; in addition, the lack of maturation of drug elimination processes, alteration of body composition and influence of size render the calculation of drug doses complex in infants. The commonest drug administration error in infants is one of dose, and the commonest hospital site for this error is the intensive care unit. Drug errors are a consequence of system error, and preventive strategies are possible through system analysis. The goal of a zero drug error rate should be aggressively sought, with systems in place that aim to eliminate the effects of inevitable human error. This involves review of the entire system from drug manufacture to drug administration. The nuclear industry, telecommunications and air traffic control services all practise error reduction policies with zero error as a clear goal, not by finding fault in the individual, but by identifying faults in the system and building into that system mechanisms for picking up faults before they occur. Such policies could be adapted to medicine using interventions both specific (the production of formulations which are for children only and clearly labelled, regular audit by pharmacists, legible prescriptions, standardised dose tables) and general (paediatric drug trials, education programmes, nonpunitive error reporting) to reduce the number of errors made in giving medication to infants.

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Challenges in providing pharmaceutical care to pediatric patients

Cited by 6 publications

References 0 publications

The Kinetic Profile of Gentamicin in Premature Neonates

The Kinetic Profile of Gentamicin in Premature Neonates

Pharmacokinetics in Children: History, Considerations, and Applications

Common Errors of Drug Administration in Infants

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