OBJECTIVE Levetiracetam is traditionally given as an intravenous (IV) piggyback over a span of 15 minutes. Studies have shown administration of levetiracetam via IV push is safe and effective in adults; however, there are limited data within pediatrics. The objective of this study was to assess the safety and tolerability of IV push administration of undiluted levetiracetam in pediatric patients from neonates to 17 years of age. METHODS This was a single-center, retrospective observational study of pediatric patients who received at least 1 dose of undiluted IV push levetiracetam at a combined pediatric and adult community medical center. Patients were included if they were younger than 18 years and received an IV push dose of levetiracetam of 19 mg or greater. Patients were excluded if they received IV push lacosamide in addition to IV push levetiracetam. The primary outcome was treatment-associated adverse events within 1 hour of levetiracetam administration. RESULTS A total of 103 patients, with an associated 446 levetiracetam administrations, were identified for inclusion in this study. The mean age at the time of levetiracetam administration was 8 years (range, 1 day–17 years). There were 46 treatment-associated adverse events (10.3%) identified within the first hour after administration. The most common adverse events identified included increased blood pressure (85%), agitation (4%), drowsiness (4%), and hypotension (4%). The highest score obtained was 6 on the Naranjo Adverse Drug Reaction Scale, which is considered a probable reaction. CONCLUSIONS Undiluted, IV push levetiracetam appears to be safe in pediatric patients from neonates to 17 years of age.
There are limited antimicrobial options for the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB). Sulbactam-durlobactam was recently approved for the treatment of CRAB in patients 18 years and older. However, CRAB infections can have mortality rates up to 80% in the intensive care unit. We describe the successful novel use of sulbactam-durlobactam in a pediatric patient using available adult pharmacokinetic data and preliminary pediatric dosing suggestions from a phase 1b trial.
OBJECTIVE In the United States, approximately 100,000 people currently live with sickle cell disease. Despite the prominence of disease, there remains room for enhancing patient care. The use of hydroxyurea has improved patient outcomes, showing a decrease in vaso-occlusive crises, acute chest syndrome, the need for blood transfusions, and mortality. Other strides in management include antibiotic prophylaxis for younger patients, optimization of immunizations, and institution of novel agents. METHODS The purpose of this study was to evaluate pediatric patients with sickle cell disease at a single institution by assessing adherence to the prescribing practices of evidence-based pharmacologic therapy. The primary outcome was evaluation of prescribing practices of hydroxyurea or erythrocytapheresis, antibiotic prophylaxis, and immunizations. Secondary outcomes include the prescribing of novel therapies, the evaluation of hydroxyurea dosing, and the comparison of vaccination rates with a previous study completed at the same institution. Data collected include active therapy with hydroxyurea or erythrocytapheresis, supportive care with antibiotic prophylaxis for patients younger than 5 years, and vaccination adherence per current guideline recommendations. RESULTS A total of 104 patients were included. Of those reviewed, 79% were prescribed hydroxyurea, and 17% were receiving erythrocytapheresis. Supportive care results showed 100% of patients younger than 5 years were receiving appropriate antibiotic prophylaxis. On comparison with a previous institutional analysis, those up-to-date on vaccinations were 66% vs 9.4% (p < 0.05). CONCLUSIONS Results demonstrated high prescribing rates of therapy with either hydroxyurea or erythrocytapheresis and antibiotic prophylaxis but highlighted the continued opportunity to improve vaccination rates.
Immunization misinformation is rampant, and it is essential that pharmacists remain able to interpret, explain, and recommend evidence-based immunization information to parents and other health care professionals. The Pediatric Pharmacy Association’s Immunization Committee strives to provide summaries of important evidence regarding changes to immunizations and clarify confusing or new immunization issues. We intentionally did not include long-standing issues that have already been well addressed elsewhere, either by our committee previously or by other national organizations. In this article, we address the background of immunization approvals, why placebo-controlled trials are not usually optimal, how and why immunization recommendations vary between countries, why it is essential to continue to obtain high rates of immunizations among children, as well as the safety of immunizations containing aluminum and yeast.
There are no studies evaluating cefepime pharmacokinetics (PK) in pediatric patients receiving intermittent hemodialysis (iHD). Cefepime dosing in this population is particularly challenging owing to several variables that can affect clearance, including dialysis prescription, residual kidney function, fluid overload, and systemic inflammation. We describe cefepime PK parameters and concentration time profiles in an adolescent male undergoing iHD for whom a cefepime PK consult was requested. Using model-informed precision dosing, we were able to ensure the patient’s current dosing of cefepime at 1000 mg daily maintained estimated free cefepime concentrations above 4 times the minimum inhibitory concentration (MIC) for MICs up to ∼4 mg/L while avoiding excessively high trough concentrations. Despite suspicion for increasing residual kidney function, due to increasing urine output, the patient’s PK parameters were very similar 4 months later, when an additional consult was requested. This is the first published case describing cefepime PK in an adolescent on iHD and demonstrates the utility of model-informed precision dosing in this population.
