The immunomodulatory actions of cimetidine, an H2-receptor antagonist, and its use in the treatment of viral warts has been described previously but its effectiveness is still debated. We report the results in 47 patients with multiple, nongenital viral warts who were treated with oral cimetidine in a 3-month open-label study. The drug was generally well tolerated and 87% of children and 68% of adults improved with treatment. Follow-up data in 65% of the patients showed that there had been no recurrence in the majority of those whose warts had cleared completely during treatment, whereas warts tended to persist or recur in those who had stopped treatment before all the warts had resolved. Our data suggests that cimetidine may be helpful in the treatment of viral warts in both adults and children and supports the need for a randomized controlled trial.

There is currently insufficient evidence to determine the effect of ataluren as a therapy for people with cystic fibrosis with class I mutations. Future trials should carefully assess for adverse events, notably renal impairment and consider the possibility of drug interactions. Cross-over trials should be avoided given the potential for the treatment to change the natural history of cystic fibrosis.

IBW) for height prescribing in grossly oedematous or overweight children. Additionally, a stronger focus was placed on antibiotic stewardship. For instance, following two gentamicin doses the prescriber is prompted to review diagnosis, culture results and on-going antimicrobial indication. A further prompt for Paediatric Infectious Diseases discussion is highlighted in treatment courses exceeding five doses. Methods A rapid-fire PDSA QI approach was employed, with contribution from Paediatric Infectious Diseases, Paediatric Nephrology and Pharmacy departments. The team pursued this project during the COVID-19 pandemic, despite some initial colleague hesitancies. Throughout implementation, the chart design, content and accessibility were regularly scrutinised. An initial three month pilot was conducted in RBHSC PICU & surgical ward (August-November 2020), prior to hospital-wide adoption. Pre-and post-implementation multidisciplinary education sessions helped to embed its clinical use and facilitate user feedback. Following pilot, the chart was amended to include specific instructions to review both anaesthetic and emergency department records, to ensure gentamicin doses weren't missed. An audit of toxic gentamicin levels (!1), renal function monitoring and associated AKI was conducted, comparing serum gentamicin levels sent in the 6 months prior to and following chart introduction. Quantitative and qualitative staff feedback was also obtained. Results Audit data showed improvement in renal function monitoring (84.6% to 100%) and associated reduction in AKI (33.4% to 22.2%), following chart introduction. However, similar levels of gentamicin toxicity were encountered before and after chart implementation (9.8% and 10.7% of all gentamicin results respectively). Staff feedback was overwhelmingly positive, with 100% of prescribers agreeing the chart enhanced their knowledge of therapeutic drug monitoring, and prescription and monitoring in renal impairment. Furthermore, regional implementation was supported by all survey respondents. New relationships with laboratory colleagues has facilitated the development of an auto-analysis function to process creatinine results when serum gentamicin levels are requested; this will help to limit clinician variability and may prompt enhanced AKI recognition. Conclusions A collaborative, multi-professional approach to a standardised gentamicin prescription chart will help to harmonise paediatric clinical care throughout Northern Ireland and may contribute to improved antimicrobial prescribing, monitoring and stewardship.