Vincristine, a cornerstone vinca alkaloid in pediatric oncology, has historically been regarded as a low-risk agent for drug-induced acute pancreatitis (DIAP). We report the first documented pediatric case of vincristine monotherapy-associated acute pancreatitis, challenging existing toxicity paradigms. A 3.25-year-old boy with stage IV Wilms tumor developed acute-onset fever and localized periumbilical pain 48 h after vincristine infusion (0.9 mg), administered within standard dosing. Laboratory testing confirmed marked pancreatic hyperenzymemia (serum α-amylase 2,022 U/L, 12.5 × ULN; lipase 568 U/L, 7.1 × ULN), and contrast-enhanced ultrasonography revealed pancreatic edema. A Naranjo score of 7 indicated probable causality, further supported by complete symptom resolution after substitution with vindesine and no recurrence during six months of follow-up. Genetic testing showed no CEP72 (rs924607) susceptibility variant, suggesting a hypersensitivity rather than pharmacogenomic mechanism. This case highlights the need to re-evaluate vincristine's DIAP risk profile in children and supports implementing routine post-infusion monitoring of pancreatic enzymes in high-risk patients. Vindesine may serve as a safe and effective alternative agent. These findings underscore the importance of updating pediatric chemotherapy safety guidelines for vinca alkaloid-containing regimens.

OBJECTIVE:To develop and validate a rapid, evidence-based benefit-risk assessment index for off-label drug use in pediatrics, thereby promoting standardized clinical decision-making. METHODS:Under the auspices of the Guangdong Pharmaceutical Association, a multidisciplinary expert panel from pediatrics, pharmacy, methodology, and ethics was convened. Systematic literature searches informed a preliminary index framework. Three Delphi rounds refined indicators. Weights were assigned using the analytic hierarchy process. Expert-based validation involved 20 hematology-oncology experts assessing 10 cases; intraclass correlation coefficient (ICC) and Spearman's correlations evaluated reliability and validity. RESULTS:The index consists of 2 primary dimensions (benefits: 56 points; risks: 44 points), 10 third-level, and 40 fourth-level indicators, with five prerequisites (e.g., no alternatives, informed consent). The ICC was 0.77 (good reliability); Spearman's correlations were rs = 0.97 (benefits) and rs = 0.68 (risks) (both p < 0.05), indicating strong alignment with expert consensus. Junior experts showed lower correlations (benefits rs = 0.89; risks rs = 0.56) than seniors (benefits rs = 0.97; risks rs = 0.78), highlighting the system's role in standardizing assessments. CONCLUSION:This quantitative index provides an evidence-based tool for pediatric off-label drug decisions, supporting clinicians, policymakers, and standardization efforts.

A BF 2 -bridged J-aggregate on the D–A conjugated oligomer CH-1 was designed for in vivo NIR-II imaging-guided tumour theranostics under 808 nm laser illumination.

Background Thalidomide serves as a rescue therapy for refractory pediatric Inflammatory Bowel Disease (pIBD), but its use is constrained by the risk of thalidomide-induced Peripheral Neuropathy (TiPN). The quantitative relationship between cumulative dose and TiPN, as well as the risk profile in the specific population of Very Early-Onset IBD (VEOIBD), lacks precise evaluation. Methods We conducted a single-center, retrospective cohort study of children with IBD treated with thalidomide from 2018 to 2025. We compared cumulative thalidomide doses between TiPN and non-TiPN groups and employed ROC curve analysis to determine a predictive dose threshold. The cohort was further stratified into VEOIBD and pIBD groups to compare dynamic inflammatory marker changes and overall drug tolerability. Results Among 49 included patients, the incidence of TiPN was 26.5% (13/49). The cumulative thalidomide dose was significantly higher in the TiPN group (median 19.5 g vs. 8.35 g, p = 0.008). A cumulative dose threshold of > 15.38 g predicted TiPN with an AUC of 0.756 (sensitivity 0.722, specificity 0.692). While VEOIBD patients (n = 14) had a distinct disease treatment history, they experienced significantly fewer overall adverse events than pIBD patients (3/14 vs. 19/35, p = 0.04), with no significant difference in TiPN incidence. Conclusions Cumulative thalidomide dose is a strong predictor of TiPN in children with IBD. Despite being a more refractory population, VEOIBD patients demonstrated better overall tolerance to thalidomide. Monitoring cumulative dose is crucial for mitigating neurotoxicity and optimizing thalidomide therapy in pIBD.

Background: Although triptorelin acetate (TA) is generally considered a safe medication, severe adverse drug reactions (ADRs) to triptorelin have occurred. In this study, we present the largest retrospective analysis of ADRs related to TA during the treatment of pediatric central precocious puberty. Methods: We describe a total of 38 suspected cases of TA-induced ADRs reported to the pharma-covigilance center of Shenzhen Children’s Hospital from September 2015 to December 2022. Causality assessment was carried out using the validated Kramer’s algorithm. The severity of ADRs was evaluated using the Modified Hartwig and Siegel Scale. Results: The most common ADRs attributed to TA were damage to the cutaneous tissues (29.3%) and reactions affecting the systemic and digestive systems (20.7%). The majority (61.1%) of ADRs occurred within 2 hours of administration. Among the 12 patients with severe ADRs, the three most frequent symptoms were anaphylactic reactions, hip synovitis, and arthralgia. Additional-ly, six patients experienced ADRs due to a change in the manufacturing process. Conclusion: The majority of ADRs observed in pediatric cases were type I anaphylactic reactions, which are rare but life-threatening. It is advisable to perform skin prick tests and intradermal tests when switching pharmaceutical manufacturers.

Background:The package insert is a key reference and legal basis for clinical medication. However, in the field of rare diseases, advances in diagnosis and treatment often outpace updates to drug labels, resulting in widespread off-label drug use-a practice that is particularly common and often unavoidable in pediatric populations. Inappropriate off-label use, however, carries significant clinical and safety risks. Methods:Under the guidance of the Rare Disease Expert Committee of the Guangdong Pharmaceutical Association, a multidisciplinary panel of experts from clinical medicine, pharmacy, and related specialties developed the "Expert consensus on the off-label use of drugs for pediatric rare diseases in China (2025 edition)". The consensus integrates available evidence, clinical experience, evidence quality, and medication safety profiles, and was finalized after several rounds of rigorous iterative review. Results:The consensus presents 73 recommendations on off-label drug use across 21 rare diseases, organized in a tabular format for clarity and ease of reference. Conclusions:This consensus aims to standardize the management of off-label drug use in pediatric rare diseases. It supports medical institutions in developing off-label drug formularies, promotes rational drug use, and helps address the diagnostic and therapeutic needs of pediatric rare disease patients. Furthermore, it contributes to the establishment of a structured evaluation and management framework for off-label drug use in this clinical context.

PURPOSE:This research aimed to establish a population pharmacokinetic (PPK) model for busulfan (Bu) in Chinese pediatric patients with thalassemia major. We analyzed pharmacokinetic (PK) parameter variability and explored potential covariates affecting Bu disposition using patient data. These findings are intended to support the optimization and personalization of Bu dosage regimens for children with thalassemia major. METHODS:Concentration-time samples were collected retrospectively from 62 pediatric patients with thalassemia major. These patients had previously received intravenous Bu as a preparatory regimen for allogeneic hematopoietic stem cell transplantation (allo-HSCT). A PPK model of Bu was developed through nonlinear mixed-effects modeling. This modeling process, conducted using NONMEM software, concurrently involved data analysis and examination of the effect of covariates on Bu pharmacokinetics. For validation purposes, the resulting model was evaluated against an external dataset consisting of 20 individuals. RESULTS:The pharmacokinetic results were optimally analyzed using a model that incorporated a onecompartment model with first-order elimination. Body surface area (BSA) was subsequently identified as the most significant factor influencing both Bu clearance (CL) and volume of distribution (V). Diagnostic evaluations, encompassing goodness-of-fit plots, normalized prediction distribution errors, and visual predictive checks, confirmed the satisfactory fit and predictability of the final PPK model. Moreover, prediction- based diagnostic indices (MDPE%, 15.75; MAPE%, 22.26; F20%, 45.71; and F30%, 58.57) from external validation showed that no significant bias was detected when comparing the model's predicted concentrations against the observed data. CONCLUSION:The present study developed the first PPK model characterizing the pharmacokinetics of Bu specifically in children with thalassemia major. This study's final PPK model demonstrated that BSA was the key predictive covariate for CL and V.

With the increasing importance of single-cell analysis in many fields, such as biology and medicine, developing efficient and accurate high-throughput single-cell analysis technology has become a research hotspot. Herein, an intelligent microscopic imaging system based on microarray chips is reported to achieve high-throughput analysis of single cells. The system integrates a special microwell array chip, which can accurately locate and fix many single cells, providing a stable basis for the subsequent single-cell heterogeneity analysis. At the same time, it is equipped with an intelligent microscopic imaging module, which can obtain single-cell image data quickly and efficiently through an automated image acquisition program. The system, combined with advanced image analysis algorithms, can accurately extract key features such as the morphology and fluorescence signals of single cells from massive images and then realize in-depth analysis of multiple biological characteristics of single cells. As a proof of concept, six different types of cancer cells were selected A549, H1299, CT2A, SAOS-2, SH-SY5Y, U87, respectively. By processing 3900 microwell arrays on the chip, 2000 single cells were located and fixed simultaneously. The experimental results showed that the intelligent microscopic imaging system had shown good accuracy (90 %), repeatability, and high efficiency in high-throughput single-cell analysis, which is expected to provide strong technical support for many fields such as basic research in life science, disease diagnosis, and drug development, and significantly promote the research progress at the single-cell level.

Purpose: To systematically evaluate the safety, dosing regimen, and efficacy of selexipag for pediatric patients with pulmonary hypertension (PH). Methods: A literature search of the electronic databases of PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar was performed from inception through February 28, 2023. Two reviewers independently searched and evaluated the quality of the studies and pooled data when appropriate. Full-text articles of studies of children diagnosed with PH and treated with selexipag were eligible. Pediatric patients with PH were classified into 2 groups: the add-on therapy group, in which selexipag was used as a third therapy in addition to the baseline treatment, and the transition therapy group, in which patients were switched from parenteral prostacyclin analogs to selexipag. Findings: Fourteen studies involving 58 pediatric patients with PH were included. All studies were either case reports or case series. Overall, 30 and 28 patients were in the add-on and transition therapy groups, respectively. In both groups, selexipag was initially administered as 50-200 mu g twice daily and titrated to a tolerated dosage of 200-1,600 mu g twice daily. Prostacyclin analogs were simultaneously weaned for patients in the transition group. In the add-on therapy group, 16 patients (80.0%) were at low risk of the World Health Organization functional class (WHO FC I/II), 12 (76.9%) were at low risk of the 6-minute walk distance (6MWD; > 350 m), and 21 (95.5%) were at low risk of the pulmonary vascular resistance index (PVRi; < 20 WU/m(2) ). Furthermore, N-terminal probrain natriuretic peptide and mean pulmonary arterial pressure were significantly improved. More than 70% of patients experienced common tolerable side effects, such as headache, nausea, and diarrhea. In the transition therapy group, 5 patients (55.6%) were at low risk according to WHO FC I/II, 6 (66.7%) were at low risk according to 6MWD, and 14 (87.5) were at low risk according to PVRi; however, selexipag had no significant effect on their hemodynamic parameters. Additionally, more than 80% of patients experienced no side effects. Implications: Selexipag as add-on therapy or for transition from prostacyclin analogs may have a favorable safety profile and potential efficacy for pediatric patients with PH. Further high-quality evidence of the efficacy and safety of selexipag for the treatment of pediatric PH is warranted.

Objective: The first-line treatment for severe Pneumocystis carinii pneumonia (PCP) is trimethoprim-sulfamethoxazole (TMP/SMZ). Here, we report a case involving 6-month-old child with a PCP infection, highlighting the role of clinical pharmacists in providing individualized pharmaceutical care and guidance through the process of therapeutic drug monitoring (TDM). Methods: The clinical pharmacist monitored the concentration of TMP/SMZ in the serum, urine and sputum of a 6-month-old child with PCP infection. To improve the serum levels of TMP/SMZ, the dose of TMP/SMZ was increased, while infusions of other medications were reduced to decrease the rate of drug excretion. Additionally, the patient received other supportive medications to enhance clinical therapeutic efficacy. Results: Clinical pharmacists observed that, despite administration of a sufficient dose of TMP/SMZ, plasma concentration of TMP/SMZ remained below the therapeutic window, while urine concentrations were extremely high. This phenomenon was attributed to Augmented Renal Clearance (ARC), often seen in critically ill patients and associated with increased renal clearance. Throughout treatment, the concentrations of SMZ remained below the minimum effective concentration, while the concentrations of TMP fell within the effective target range. However, sufficient therapeutic effects were ultimately achieved and observed in the patient, likely due to improved drug distribution in lung tissue (sputum) and the patient's recovering immune functions. Finally, thanks to individualized pharmaceutical care from clinical pharmacists and the combined efforts of clinicians, the patient was discharged after 58 days of hospitalization. Conclusion: Throughout treatment, the clinical pharmacist played a vital role in optimizing the treatment plan based on the serum, urine and sputum concentrations of TMP/SMZ and providing pharmaceutical care to ensure a safe, rational and effective medications in children. Individualized dose adjustments, particularly high-dose TMP/SMZ guided by TDM, can significantly enhance the management of PCP in pediatric patients and support clinical pharmacists in delivering individualized pharmaceutical care.

Changes in physiological factors may result in large pharmacokinetic variability of vancomycin in pediatric patients, thereby leading to either supratherapeutic or subtherapeutic exposure and potentially affecting clinical outcomes. This study set out to characterize the disposition of vancomycin, quantify the exposure target and establish an optimal dosage regimen among the Southern Chinese pediatric population. Routine therapeutic drug monitoring data of 453 patients were available. We performed a retrospective population pharmacokinetic analysis of hospitalized children prescribed intravenous vancomycin using NONMEM® software. A one-compartment PPK model of vancomycin with body weight and renal functions as covariates based on a cutoff of 2 years old children was proposed in this study. Both internal and external validation showing acceptable and robust predictive performance of the model to estimate PK parameters. The value of area under the curve over 24 h to minimum inhibitory concentration ratio (AUC0-24/MIC) ≥ 260 was a significant predictor for therapeutic efficacy. Monte Carlo simulations served as a model-informed precision dosing approach and suggested that different optimal dose regimens in various scenarios should be considered rather than flat dosing. The evaluation of vancomycin exposure-efficacy relationship indicated that lower target level of AUC0-24/MIC may be needed to achieve clinical effectiveness in children, which was used to derive the recommended dosing regimen. Further prospective studies will be needed to corroborate and elucidate these results.

Introduction: Due to its highly aggressiveness and malignancy, glioblastoma (GBM) urgently requires a safe and effective treatment strategy. Zeylenone, a natural polyoxygenated cyclohexenes compound isolated from Uvaria grandiflora, has exhibited potential biological activities in various human diseases, including tumors.Methods: We designed and synthesized a series of (+)-Zeylenone analogues and evaluated their anti-GBM roles through structural-activity analysis. Cell Counting Kit-8, TUNEL, transwell and flow cytometry were employed for investigating the anticancer effects of CA on GBM cells. Western blotting, molecular docking, qRT-PCR and ChIP assays were performed to reveal the underlying mechanisms by which CA regulates the GBM cell cycle. The nude mouse xenograft model, HE staining, immunohistochemistry and was used to evaluate the anticancer effect of CA in vivo.Results: We identified CA ((1R, 2R, 3S)-3-p-fluorobenzoyl-zeylenone) as having the lowest IC50 value in GBM cells. CA treatment significantly inhibited the malignant behaviors of GBM cells and induced G0/G1 phase arrest in vitro. Furthermore, we validated the molecular mechanism by which CA interferes with EZH2, attenuating the down-regulation of cyclin-dependent kinase inhibitors p27 and p16 by the PRC2 complex. By establishing orthotopic nude mice models, we further validated the inhibitory role of CA on tumorigenesis of GBM cells in vivo and its potential values to synergistically potentiate the anti-tumor effects of EZH2 inhibitors.Conclusion: Overall, this paper elucidated the anti-GBM effects and potential mechanisms of CA, and may provide a therapeutic drug candidate for GBM treatment.

Glioma is recognized as one of the most lethal and aggressive brain tumors. Although the standard-of-care treatment for glioblastoma (GBM) involves maximal surgical resection and temozolomide (TMZ) chemotherapy, the discovery of novel anti-tumor agents from nature sources is an effective strategy for glioma treatment. In this study, we conducted a screening process to identify the bisindole alkaloid melodinine J (MDJ) from Melodinus tenuicaudatus. We assessed its potency in overcoming TMZ resistance in patient-derived recurrent glioma strains, TMZ-resistant cell lines, and nude mouse tumor models of glioma cells. Our results first indicated that MDJ effectively inhibited malignancy and stimulated apoptosis in glioma. Mechanistic studies revealed that MDJ triggered deadly mitochondrial dysfunction and apoptosis by disrupting cross-organellar communication between the endoplasmic reticulum (ER) and mitochondria-associated membranes (MAMs). We also showed that high levels of TMX1 may promote malignancy of glioma by ER-mitochondria communications, bioenergetics efficiency, and tumor growth. Overall, our study proved that MDJ interfered the function of TMX1-mediated MAM networks, thereby overcoming the proliferation and chemo-resistance of glioma cells.

ObjectivesIt is well known that transporter and enzyme genes could be regulated by microRNA (miRNA) at the post-transcriptional level, and single-nucleotide polymorphisms (SNPs) in miRNA, which are involved in the miRNA production and structure, may impact the miRNA expression level and then influence drug transport and metabolism. In this study, we aim to evaluate the association between miRNA polymorphisms and high-dose methotrexate (HD-MTX) hematological toxicities in Chinese pediatric patients with acute lymphoblastic leukemia (ALL).MethodA total of 181 children with ALL were administered with 654 evaluable cycles of HD-MTX. Their hematological toxicities were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events v5. The association between 15 candidate SNPs of miRNA and hematological toxicities (leukopenia, anemia, and thrombocytopenia) was analyzed using Fisher's exact test. Further multiple backward logistic regression analysis was used to explore the independent risk factors for grade 3/4 hematological toxicities.ResultRs2114358 G>A in pre-hsa-miR-1206 was related to HD-MTX-related grade 3/4 leukopenia after multiple logistic regression [GA + AA vs. GG: odds ratio (OR): 2.308, 95% CI: 1.219–4.372, P = 0.010], and rs56103835 T > C in pre-hsa-mir-323b was associated with HD-MTX-related grade 3/4 anemia (TT + TC vs. CC: OR: 0.360, 95% CI: 0.239–0.541, P = 0.000); none of the SNPs were significantly associated with grade 3/4 thrombocytopenia. Bioinformatics tools predicted that rs2114358 G>A and rs56103835 T>C would impact the secondary structure of pre-miR-1206 and pre-miR-323b, respectively, and then probably influence the expression level of mature miRNAs and their target genes.ConclusionRs2114358 G>A and rs56103835 T>C polymorphism may potentially influence HD-MTX-related hematological toxicities, which may serve as candidate clinical biomarkers to predict grade 3/4 hematological toxicities in pediatric patients with ALL.

目的 评价玛巴洛沙韦治疗流行性感冒(以下简称"流感")的有效性、安全性和经济性,以期为医院新药引进和临床用药决策提供循证参考.方法 检索PubMed、Embase、Web of Science、Cochrane Library、Epistemonikos、中国生物医学文献数据库、中国知网、维普网、万方数据库及卫生技术评估(HTA)相关学术机构官方网站及数据库,经文献筛选、资料提取、质量评价后,对研究结果进行描述性分析.结果 共纳入11篇文献,包括6篇系统评价(SR)/Meta分析、5篇经济学研究.与安慰剂相比,玛巴洛沙韦在缩短流感患者症状缓解时间(TTAS)和退热时间(TTRF)、降低治疗后24 h和48 h病毒滴度相对于基线的变化水平、降低支气管炎发生率等方面差异有统计学意义(P＜0.05).与神经氨酸酶抑制剂(NAIs)相比,玛巴洛沙韦在缩短流感患者TTRF,降低流感并发症、肺炎、支气管炎发生率等方面差异无统计学意义(P＞0.05);多数研究认为玛巴洛沙韦在缩短TTAS方面差异无统计学意义(P＞0.05);仅有极低质量文献认为玛巴洛沙韦可显著降低患者治疗后24 h和48 h病毒滴度相对于基线的变化水平.安全性方面,玛巴洛沙韦与帕拉米韦、扎那米韦相比,不良事件(AEs)发生率和药物相关不良事件(DRAEs)发生率差异无统计学意义(P＞0.05).部分研究认为玛巴洛沙韦AEs和DRAEs发生率较安慰剂、奥司他韦、拉尼米韦更低.现有经济学研究显示,在中国与奥司他韦相比、在日本与拉尼米韦相比,玛巴洛沙韦均更具有成本-效果优势.结论 与安慰剂相比,玛巴洛沙韦治疗流感具有良好的有效性、安全性和经济性.与NAIs(奥司他韦)相比,玛巴洛沙韦在中国有良好的经济学优势,但在安全性和有效性方面尚需开展更多高质量研究.

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Background Antimicrobial agents’ wastage is a huge problem, especially for pediatric patients, resulting in excessive drug expenditure and increasing the economic burden on patients’ families. Moreover, the cost of disposing of antimicrobial agents’ waste and the risk of environmental and occupational exposure also increased. This study aimed to explore the cost-effectiveness of the vial-sharing strategy combined with the daily-rate charge mode for pediatric inpatients to provide a strategy for reducing patients’ expenditures, saving medical costs, and reducing drug proportion. Methods This retrospective study was conducted at Pharmacy Intravenous Admixture Service (PIVAS), Shenzhen Children’s Hospital, Guangdong Province, China, in 2022. Data on prescription drugs were collected from the PIVAS system. Ten antimicrobial drugs with a frequency of prescriptions no less than twice once daily were selected, and the drug costs, drug weight, and drug saved were further analyzed according to the combination of real-time vial sharing strategy and daily-rate charge mode. Traditional single vial charge mode without vial sharing was set as a control strategy. The actual expenditure of the hospital was also calculated and analyzed. Results During 2022, ¥ 4,122,099 (34.4%) was saved for inpatients by applying a vial-sharing strategy on ten antibacterial agents, and more than 46,343,750 mg (24.6%) of drugs were totally saved. The top 5 drugs saved by the real-time vial-sharing strategy were cefoperazone-sulbactam, vancomycin, amoxicillin-sulbactam, ceftazidime, and meropenem. Taken the price into consideration, the top five payment-saved drugs were vancomycin (¥ 1,522,385), meropenem (¥ 1,311,475), cefoperazone-sulbactam (¥ 736,697), imipenem-cilastatin (¥ 406,092), and amoxicillin-sulbactam (¥ 51,394). Moreover, the account balance of the hospital was up to ¥ 426,499. Conclusion The real-time vial sharing strategy combined with the daily-rate charge mode greatly reduces drug wastage and patients’ payments. It may be useful for hospitals with PIVAS to achieve vial-sharing while protecting the best interest of inpatients.

目的:调查分析全国范围内儿科口服药品分剂量现状,了解临床上分剂量使用最频繁药品的种类与规格,给出改善药品分剂量现状的建议.方法:采用问卷调查形式,收集国内30家医院2019年12月儿童口服药品医嘱数据,分别从分剂量药品种类、医嘱数量、分剂量规格、最迫切需要规格等方面进行统计与分析.结果:参加本次调查单位口服分剂量药品共计16类282种,最常分剂量种类为抗感染药物、消化系统用药和心血管系统用药,最常分剂量药品为螺内酯片、氯化钾片和呋塞米片等药品.最常分剂量规格为1/2片、1/4片及1/5片,需求最迫切的规格多为1/2片、1/3片、1/4片及1/5片.螺内酯片、呋塞米片等7种药品不仅分剂量工作量大,而且最小分剂量规格≤1/20片.结论:普遍的分剂量现象反映出我国儿童适宜药品较为缺乏.为保障儿童用药安全、有效、可及,药品分剂量工作需要政产学研用多方面共同配合.

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

AIMS:This study aimed to review the studies evaluating the effect of the inflammatory state on voriconazole (VRZ) levels. METHODS:The study included randomized clinical trials, cohort studies, and case-control studies that focused on the influence of the inflammatory state on VRZ levels. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, relevant articles published until 2021 were searched in several databases, including PubMed, Embase, Web of Science and the Cochrane Library. RESULTS:Twenty studies were included in this review, of which 15 described adult populations, three described paediatric populations, and two included both adult and paediatric populations. Seventeen studies used C-reactive protein (CRP) as an indicator of inflammation, six described a dose-response relationship for the effect of inflammation represented by CRP on VRZ concentrations, and four examined the effect of CRP on the metabolic rate of VRZ. CONCLUSIONS:Our findings showed that the level of inflammation can significantly affect VRZ levels. However, the effect of inflammation on VRZ concentrations in children is controversial and must be analysed along with age. Clinicians dosing VRZ should take into account the patient's inflammatory state. The impact of inflammation on genotype-based dosing decisions requires further study to explain the high pharmacokinetic variability of VRZ.