Volume 14: Issue 1

“Dr. Yaffe's vision of improved therapy for sick children is becoming a reality. He has inspired an entire generation of pediatric clinical pharmacologists to grow the field into a mature and evolving scientific discipline.”
–Stephen P. Spielberg

It is my distinct honor to have been selected by the Pediatric Pharmacy Advocacy Group (PPAG) to be the 2008 recipient of the Sumner J. Yaffe Lifetime Achievement Award and to join the august group of Pediatricians and Pharmacists who have also received this great honor. As reflected by the aforementioned quote excerpted from a biographical sketch of Dr. Yaffe published by

OBJECTIVES Specific organisms can be added to foods to target an effect (probiotics) or non-digestible carbohydrates can be used to foster the development of a favorable flora in the intestinal tract (prebiotics). The significance of pro- and prebiotics have been studied extensively, providing many current and theoretical treatment options. The objective of this paper is to provide a brief overview of commercial products available for the practicing clinician.

METHODS The literature was evaluated for the most commonly used and studied pre- and probiotics available. In addition, information regarding each of the products was obtained from the manufacturer.

RESULTS We found that all products are not formulated the same and the content of live organisms can differ. Currently available products are relatively safe but caution should be used for any patients that may have allergies to inactive ingredients in the product or are immunocompromised.

CONCLUSIONS Many probiotics and prebiotics are commercially available to aid in promoting healthy bowel flora to resist disease. This reference can be a helpful tool for the pharmacist when answering questions or making recommendations to a patient.

OBJECTIVES Patient morbidity and mortality associated with contaminated and improperly prepared sterile products has captured national attention. In response, both the United States Pharmacopeia (USP) and Centers for Disease Control (CDC) have published recommendations in an effort to minimize the risk of infection. While the CDC recommends that administration sets are not changed more frequently than every 72 hours, the USP recommends a maximum beyond use date of 48 hours. Neither organization provides specific guidance on expiration dating once the intravenous drug is dispensed. Likewise, neither addresses the length of time that a bag containing medication for continuous infusion may hang once administration to the patient has begun. We evaluated the sterility of medications that are commonly administered by continuous infusion to pediatric patients. Because frequent manipulation of infusion and administration sets may predispose the patient to adverse events, we evaluated sterility for extended beyond use dating up to 72 hours.

METHODS Thirty-five common intravenous (IV) continuous infusions using 94 standard concentrations and diluents were identified. IV solutions were mixed using sterile technique in the laminar flow hood in accordance with USP guidelines. Medications were excluded for short stability, short durations of use or high cost. A sample from each solution was tested for contamination or bacterial growth at 72 hours. Any visible discoloration suggesting physical instability was also evaluated.

RESULTS None of the syringes or chambers resulted in contamination, bacterial growth or discoloration after 72 hours.

CONCLUSIONS This study provides sufficient data that these compounded sterile products may be stored using a beyond use date up to 72 hours for a number of commonly used continuous IV infusions in pediatric patients. In our institution, this allows for a more convenient and consistent change of both administration sets and continuous infusions at 72 hours to potentially minimize adverse events, workload and cost.

OBJECTIVES 1)To assess the awareness of pediatricians regarding the potential problems caused by children taking their medications before or during school hours 2) To identify the types of interventions pediatricians use to manage these issues 3)To assess the views of pediatricians regarding how well the process of medication management is handled by the schools that their patients attend.

METHODS Thirty-five pediatricians completed a questionnaire inquiring about their prescribing habits for children under the age of 18, their views on the possible effects medications may have on children while at school, and what they do to minimize problems that may be associated with taking or being under the influence of medications while at school.

RESULTS The largest group of responding physicians (42.9%; n = 15) selected “Somewhat Common” when asked how common it is that they prescribe medications that must be used before or during school hours. The majority of responding pediatricians surveyed (62%; n = 21) believe that taking medications at school can create special problems. The majority of respondents (59.4%; n = 19) disagree with the statement that “Medications in Illinois schools are well managed by a trained agent. These pediatricians utilize a variety of strategies to minimize problems caused by medication use during or before school, and the most common of these is the prescribing of sustained release products.

CONCLUSIONS Pediatricians who responded to a survey are aware of potential problems associated with children being under the influence of, or taking medications during school hours. As a result, many have devised ways to ameliorate and/or prevent potential problems.

The most discussed change in parenteral nutrition compatibility within the last two years was with ceftriaxone. In the summer of 2007, Roche Laboratories updated their prescribing information for Rocephin^® (ceftriaxone sodium) to include a contraindication for the co-administration of ceftriaxone with calcium-containing intravenous solutions in neonates due to reported fatal cases of pulmonary and renal precipitates in this patient population.1 The additional warnings to avoid a potential interaction are the most controversial. It is now recommended that ceftriaxone and calcium-containing intravenous solutions, such as parenteral nutrition, not be administered within 48 hours of each other regardless

Gluten-Free Options for the Top 100 Pediatric Medications

Kelly L. MatsonPharmD,

Clara L. ForbesPharmD, and

Katelyn E. BurtonPharmD

Patent Ductus Arteriosus: Indomethacin, Ibuprofen, Surgery, or No Treatment at All?

The Pursuit of Pediatric Clinical Pharmacology: Perspectives from a Current Journey

Probiotics and Prebiotics: Why Are They “Bugging” Us in the Pharmacy?

Analysis of 72-Hour Sterility of Common Pediatric Continuous Intravenous Infusions

Medication Management in Primary and Secondary Schools: Assessing the Practices and Opinions of Pediatricians

Recombinant Factor VIIa for Bleeding in Non-hemophiliac Pediatric Patients

Y-Site Compatibility of Medications with Parenteral Nutrition

Gluten-Free Options for the Top 100 Pediatric Medications

Pediatric Antibiotic Stewardship Programs: The Path Forward

Inhaled Tobramycin Usage in Critically Ill Pediatric Patients Without Cystic Fibrosis: A Pediatric Pharmacy-Association, Practice-Based Research Network Survey Study

Acne Vulgaris in Children and Adolescents: What’s the Cause and How to Combat It

Nontraditional Antiseizure Medications to Consider When Traditional Options Have Failed: Medications for Refractory Seizures and Epilepsies