Although pediatricians usually take great care in accurately calculating medication for their patients, the important processes of measuring and administering the dose are often overlooked. Many of the problems encountered in the administration of tablets and capsules to small children have been overcome by the production of medications in liquid form. However, the advantage gained in the administration of liquid products is often lost because of the inaccuracy of the devices used to measure and administer them. Liquid doses may be inaccurate for several reasons. The measuring devices commonly used today include household spoons, cups, and specific devices provided by pharmaceutical manufacturers to be used with their products. Teaspoons are particularly poor measuring and administering devices. The measured capacity of the teaspoon has been shown to be within the range of 2.5 to 7.8 ml.1,2 In addition, teaspoons are a poor delivery device because they tip easily. Furthermore, the same spoon, when used by different persons, may deliver from 3 to 7 ml.3 Such variations may be related to factors such as pouring the liquids from different-sized bottles, the color of the liquids, and the adequacy of available light. Perhaps the most important factor in measurement is related to the care practiced by the person doing the measuring. Although the American Pharmaceutical Association (in 1902) and the American Medical Association (in 1903) defined the "standard teaspoonful" as 5 ml, this recommendation has not been universally adopted.4 The practice of some pharmaceutical manufacturers of establishing doses in 4-ml and other fractions of a "teaspoon" tends to confuse the prescribing physician when it comes to instructing patients.
The disposition of coadm,inistered tic,ircillin (3 g/1.73 m2) and clavulanic acid (100 mg/1.73 m2) was examined after a 30-min infusion in 24 noninfected subjects with various degrees of renal function. Noncompartmental pharmacokinetic parameters for the individual compounds were determined from plasma concentrations and urinary excretion rates. All clearances (total, renal, and nonrenal) and urinary recoveries of unchanged drug were found to be linearly related to creatinine clearance (CLcR). The steady-state volume of distribution (9.9 and 12.9 liters for ticarcillin and clavulanic acid) approximated the extracellular fluid space and was not related to CLCR. The half-lives increased with redqced renal function and ranged from 56 to 392 min for ticarcillin and 26 to 266 min for clavulanic acid. The clearances of both drugs decreased proportionately with reduction in renal function, facilitating dosing adjustments based on CLCR. Calculations of expected steady-state maximum and minimu,, concentrations in pla,sma using constant doses and an extended dosing interval related to CLCR further rationalized use of the 30:1 drug combination ratio for all patients.Ticarcillin is a wide-spectrum penicillin which can be hydrolyzed by a number of beta-lactamases. Clavulanic acid is a potent inhibitor of these enzymes, and a synergistic effect is exhibited when the two agents are coadministered (5,18,20). A ticarcillin:clavulanic acid combination of 30:1 is used clinically, partly on the basis of pharmacokinetic matching in subjects with normal renal function (1).Previous studies evaluated the pharmacokinetics of ticarcillin and clavulanic acid when administered separately (3,4) or in combination (1, 2, 6) in subjects with normal renal function, but the disposition of the combination has not been assessed in relation to renal impairment. The purpose of this study was to evaluate the pharmacokinetics of ticarcillinclavulanic acid in subjects with various degrees of renal impairment to evolve dosage guidelines and to determine whether the dosing ratio of 30:1 remains suitable in the presence of severe renal dysfunction.MATERIALS AND METHODS Subjects. A total of 24 adult subjects, aged 18 to 61 years, who gave informed written consent for the study were divided into four groups based on renal function (creatinine clearances [CLCRI, 10 to 30, 30 to 60, 60 to 80, and >100 ml min-'). By chance, there were no subjects available with CLCR between 80 and 100 ml min-'. Individuals with a history of hypersensitivity to penicillins-or cephalosporins, females with known or suspected pregnancy, and individuals on hemodialysis or peritoneal dialysis, with an infection, or with major cardiovascular or hepatobiliary dysfunction were excluded frpm the study. CLCR for each subject was determined over 24 h within 7 days before the study. Complete blood counts and blood chemistries were also performed within 7 days before the start of the study and 10 days after the study. Th1 subjects were also monitored for possible adverse effects througho...
Anaphylaxis* is an acute reaction, which may range from mild self-limited symptoms to a grave medical emergency. It is caused by a variety of agents, usually occurs unexpectedly, frequently is iatrogenic, and can be fatal if not treated promptly and appropriately. Every physician's and dentist's office, pediatric outpatient clinic, hospital emergency room, allergy clinic or allergy testing laboratory, and radiology department should be equipped to treat this potential disaster.1 The Committee on Drugs of the American Academy of Pediatrics has reviewed the equipment and procedures necessary to treat this emergency, and offers this guide to physicians. CLINICAL PICTURE Anaphylaxis is usually characterized by the following sequence of signs and symptoms: generalized flush, urticaria, paroxysmal coughing, severe anxiety, dyspnea, wheezing, orthopnea, vomiting, cyanosis, and shock. The sooner symptoms develop after the initiating stimulus the more intense the reaction. Symptoms beginning within 15 minutes after administration of the inciting agent require the most expedient management. The primary cause of death in the child is laryngeal edema. In the adult, cardiac arrhythmais may be superimposed on acute upper airway edema.2 MAJOR CAUSES OF ANAPHYLAXIS Table I lists the most common agents associated with anaphylaxis in children. The severity and acuteness of onset will depend upon both the type of agent and the route of administration. Generally, agents administered parenterally are more apt to result in severe life-threatening or fatal anaphylactic reactions than those ingested orally or administered topically to mucus membranes. Medications administered orally, such as aspirin or penicillin, however, have been associated with fatal reactions so that the oral route cannot be utilized with impunity.
The ratio of the peak serum concentration after a 500-mg dose of amikacin to the pathogen minimum inhibitory concentration was determined for 95 patients under treatment for serious Gram-negative infections. There were 113 such ratios. The relationship of this inhibitory ratio to the clinical effectiveness and side effects of treatment with this new aminoglycoside was also studied. Mean peak serum concentration of drug was 25.8 microgram/ml, and mean inhibitory ratio was 13.0. Ninety-six per cent of inhibitory ratios were greater than or equal to 1.0. Therapy was rated totally effective in 85% of patients clinically evaluated and partially effective in 3%. Signs of renal or eighth cranial nerve impairment attributable to drug administration were confined to only two patients, and there were no other side effects. The reliability of amikacin therapy appears to be related to dependable serum levels and high inhibitory ratios.
One of the most important concepts in pediatric pharmacology is that exposure to drugs or chemicals may have latent, unforeseen effects on the child later in life. Some of the most dramatic occurrences, other than teratogenesis, are those in which hormonal exposure during the fetal or newborn period alters adult sexual development. However, none of these episodes is more impressive and ominous than that reported by Herbst et al.1 Herbst, an obstetrician at the Massachusetts General Hospital, was intrigued by the presentation of seven patients with adenocarcinoma of the vagina, an extremely rare tumor not previously seen at the hospital. The patients ranged in age from 14 to 22 years and sought medical advice because of vaginal bleeding. Several had benign adenosis, suggesting that the malignant change seen in all was based on a fundamental alteration in the biology of the vaginal epithelium. Six of the patients were treated with radical surgery, and one was treated with wide, local excision. One of the patients died after surgery. In what could serve as a model of a scientifically conducted, epidemiologic study, each of the seven patients, plus an additional patient from another hospital, was matched with four controls born in the same hospital within four days. Thus, the "control" group was chosen in a manner to eliminate many biases of artificially contrived control populations. A wide variety of possible influences in both mothers and offspring were considered, e.g., maternal age, smoking habits, exposure to X-rays, breast-feeding, birth weight, age at menarche, medications during pregnancy, and so forth.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.