Administering a drug unintentionally via an incorrect route, for example intravenously instead of orally, can lead to serious adverse drug reactions. Although individual cases of incorrect routes of drug administration (IRDA) in children and adolescents have been described in the literature, a systematic analysis of a larger number of cases is lacking. The aim of this exploratory study was to analyse unintentional IRDA errors related to chemically defined drugs in two spontaneous reporting databases focusing on the drugs, dosage forms, patients involved and the clinical consequences. In this exploratory study, spontaneous reports from the European adverse drug reaction database EudraVigilance and the medication error case collection of the Federal Institute for Drugs and Medical Devices (BfArM) were used. Reports on vaccines, desensitisation treatments and manipulated dosage forms were excluded. The National Coordinating Council for Medication Error Reporting and Prevention “Index for Categorizing Medication Errors Algorithm” was used to collect data on interventions, monitoring, clinical consequences and duration of impairment. A total of 59 IRDA reports were identified across both databases. Within these reports, the most frequently identified IRDAs were intravenous instead of oral administration (22.0
Pediatric chronic spontaneous urticaria is a heterogeneous, mast cell-driven inflammatory disorder characterized by recurrent pruritic wheals, angioedema, or both persisting for more than 6 weeks, with a significant impact on patient and family quality of life. Although most children achieve disease control with second-generation H1-antihistamines, a substantial proportion remains symptomatic despite dose escalation and requires advanced treatment. Based on a structured search of PubMed/MEDLINE, Google Scholar, ClinicalTrials.gov, and regulatory sources covering publications from 2010 to 2026, this narrative review synthesizes current evidence on established and emerging therapeutic options for pediatric chronic spontaneous urticaria, with particular emphasis on age-specific efficacy, safety, regulatory status, practical treatment positioning, and the translation of adult evidence to pediatric practice. Omalizumab remains the most established second-line biologic in adolescents (aged ≥ 12 years). The recent approval of dupilumab for children aged ≥ 2 years, based on pharmacokinetic extrapolation from adult and adolescent trials, represents the first biologic option for younger children with antihistamine-refractory chronic spontaneous urticaria. Emerging therapies, including Bruton tyrosine kinase inhibitors (remibrutinib, now US Food and Drug Administration and European Commission approved for adults), anti-KIT antibodies (barzolvolimab), and Mas-related G-protein coupled receptor X2 antagonists, are expanding the therapeutic paradigm, although pediatric data remain limited. We also propose an age-adapted treatment algorithm integrating current regulatory approvals, evidence quality, and age-specific safety considerations. The availability of approved biologic therapy from 2 years of age marks a paradigm shift in this rapidly evolving field; however, dedicated pediatric trials, validated biomarkers for endotype-guided treatment, and long-term safety data in children remain critical unmet needs.
Proton pump inhibitors (PPIs) are a common treatment for gastro-esophageal reflux disease. In young children, many reflux symptoms are physiological and PPI-therapy is not always necessary. Long-term PPI use has been associated with higher risks of infections, fractures, autoimmune diseases, and allergies. Therefore, PPIs should be prescribed cautiously in young children. This study evaluated 8-year trends in PPI prescribing and purchasing among young Finnish children < 6 years, focusing on the provider sector and physician specialty. This nationwide register-based study used Finnish Prescription Centre data on all outpatient PPI prescriptions and purchases for children < 6 years (2017–2024). Annual prescription and purchase rates per 1000 children were analyzed by age group (< 1, 1–2, 3–5 years), healthcare sector (private/public), sex, and physician specialty. Among 612,428 children < 6 years, 2.9
Traumatic events are common during childhood and adolescence and may lead to acute stress disorder (ASD) or post-traumatic stress disorder (PTSD), both associated with developmental, cognitive and functional impairment. Although trauma-focused psychotherapies are recommended as first-line treatments, pharmacological interventions are frequently used in clinical practice despite limited evidence in paediatric populations. To review the evidence on pharmacological interventions for the prevention and treatment of paediatric ASD and PTSD, we reviewed the literature published up to December 2025. Eligible studies included participants aged younger than 18 years and evaluated pharmacological interventions targeting ASD, PTSD prevention or PTSD treatment. After screening and a full-text review, 75 publications were included. Given the methodological heterogeneity, findings were synthesised narratively. Evidence for pharmacological interventions in paediatric trauma-related disorders remains limited and heterogeneous. For PTSD prevention, only limited data support sertraline and, in the context of ASD, imipramine. Limited data also suggest that opioids used for pain management after trauma may reduce subsequent PTSD risk. Early opioid (morphine) exposure for pain management was also associated with lower subsequent severity symptoms in observational paediatric burn studies. Evidence for PTSD treatment is weaker. Anticonvulsants (sodium valproate, carbamazepine, oxcarbazepine, lamotrigine), antipsychotics (clozapine, quetiapine, aripiprazole), glutamatergics (D-cycloserine, ketamine, ifenprodil), propranolol and cannabidiol do not appear to provide sufficient benefit for routine use. Alpha-adrenergic agents (prazosin, clonidine, guanfacine) have shown preliminary signals of benefit, particularly for hyperarousal and trauma-related sleep disturbances. However, these findings are based on non-randomised and uncontrolled studies. Antidepressants (sertraline, citalopram) show mixed results; among them, citalopram was associated with symptomatic improvement in one small open-label study and one case series. These findings should be considered preliminary and hypothesis generating. No pharmacological treatment has sufficient evidence to warrant routine recommendation for paediatric PTSD and ASD. Pharmacotherapy should therefore be considered only as an adjunct to trauma-focused psychotherapy in selected clinical situations. Further randomised controlled trials are needed.
Isavuconazole (ISAV) is a broad-spectrum triazole antifungal approved for the treatment of invasive aspergillosis and mucormycosis and has recently received approval for use in children ≥1 year of age. Pediatric approval was based on limited registration data, underscoring the importance of real-world evidence to better define efficacy and safety in children and adolescents. In this manuscript, we reviewed pediatric registration trials and real-world studies evaluating ISAV, with a focus on treatment and prophylaxis indications, pharmacokinetics, and safety. The literature review was conducted using PubMed, Embase, and Cochrane databases to identify relevant real-world and clinical studies published between January 1, 2005, and October 31, 2025. Studies reporting ISAV use in patients <18 years of age, including registration trials, observational cohorts, case series, and pharmacokinetic–pharmacodynamic studies, were included. Twenty-six real-world publications and two clinical registration trials met inclusion criteria. Among the real-world publications, ISAV was used for treatment in 23 studies and for prophylaxis in 5 studies, while 17 studies evaluated drug exposure or pharmacokinetics (several studies involved more than one mode of administration). Most patients had underlying hematologic or oncologic conditions. Across heterogeneous study populations and outcome definitions, complete or partial response was reported descriptively in approximately 72
