Tinidazole in treatment of acute amoebic dysentery in children.

The excellent results obtained in this trial indicate that tinidazole is a drug worthy of extensive evaluation in the treatment of amoebiasis, as three single daily doses is a simple form of treatment. The drug was well tolerated and free from any toxic effects.     

Cutaneous reactions to drugs in children

Cutaneous eruptions are a commonly reported adverse drug reaction. Cutaneous adverse drug reactions in the pediatric population have a significant impact on patients' current and future care options. A patient's recollection of having a "rash" when they took a medication as a child is a frequent reason for not prescribing a particular treatment. The quick detection and treatment of cutaneous adverse drug reactions, plus identification of the causative agent, are essential for preventing the progression of the reaction, preventing additional exposures, and ensuring the appropriate use of medications for both the current condition and others as the patient ages. The purpose of this review is to discuss a reasonable approach to recognition and initial management of cutaneous adverse drug reactions in children.     

Pharmacogenomics in cancer treatment defining genetic bases for inter-individual differences in responses to chemotherapy

PURPOSE OF REVIEW: Pharmacogenomics is evolving rapidly due to the expansion of genomics and proteomics, the emerging technologies, knowledge of the molecular basis of neoplasms and of drug pathways. This article will give an update on the genetic basis of variable therapeutic responses to anticancer agents in children. RECENT FINDINGS: The majority of recent findings concern the pharmacogenetics of key components of acute lymphoblastic leukemia treatment, 6-mercaptopurine and methotrexate. This is not surprising given that leukemia is the most common cancer affecting children, accounting for 25-35% of childhood malignancies worldwide with acute lymphoblastic leukemia comprising 80% of leukemia cases. In certain patients treatment fails due to drug resistance, rendering acute lymphoblastic leukemia the leading cause of cancer-related death in children. Most of the studies use a candidate gene approach adding a new body of evidence to existing knowledge. Recent findings relating to other childhood tumors and the potential to optimize treatment of these malignancies are briefly discussed. SUMMARY: Interindividual differences in drug responses are an important cause of resistance to treatment and adverse drug reactions. Pharmacogenetics tends to identify the genetic basis of these suboptimal responses allowing traditional treatment to be complemented by genotype-based drug dose adjustment.     

Behavior-disordered and aggressive children: new advances in pharmacotherapy

The status of children's psychopharmacology is reviewed in the context of differences from its adult counterpart. An overview is presented of recent psychopharmacological developments in the treatment of childhood behavioral disorders. The disorders are grouped according to the potential usefulness of medication. The focus is on clinical efficacy and safety of drug usage. The effect of psychoactive drugs on cognitive functions in the laboratory is referred to, as well as the value of determining drug levels in clinical practice. It is concluded that drug administration in isolation is not the treatment of choice. Drug therapy is a valuable adjunct, however, to psychosocial interventions.     

Adolescent drug & alcohol use in the 21st century

Screening for drug abuse should be a part of adolescent health maintenance visits. Good interviewing skills using open-ended, nonjudgmental questions in a private setting may elicit a history of drug abuse. A detailed and comprehensive history is important to recognize family dynamics, early behavioral changes (Table 5, see page 198), comorbid psychiatric conditions, and the adolescent's attitude toward substances of abuse. A good physical exam may reveal clinical sequelae of drug abuse. Testing for drug abuse should be done with the patient's consent except in cases where judgment is impaired. Periodic screening for drugs is a part of drug treatment and rehabilitation. The typical pediatrician is not equipped to provide drug counseling and treatment to the abusing adolescent. Specialized referral centers would be ideal, and clinicians need to be aware of local resources in their communities. Anticipatory guidance explaining the ill effects of drugs is mandatory. Prevention should be aimed at increasing public awareness of the consequences of drug abuse, improving parenting techniques, and introducing school-based drug prevention programs. The fight against substance abuse needs to be a community effort in which the individual, the family and the primary care physician play important roles.     

早产儿动脉导管开放的处理

动脉导管开放(PDA)是早产儿常见病症,导致早产儿血流动力学不稳定,严重者可危及生命,应积极处理.药物关闭PDA仍是最有效、方便和经济的治疗方法,吲哚美辛一直是内科保守治疗的主要用药,PDA关闭率为46%～89%,但吲哚美辛有效血药浓度安全范围较窄,且可导致肾功能障碍、颅内出血、坏死性小肠结肠炎和肠穿孔等不良反应.近年国外采用布洛芬治疗早产儿PDA,取得较好疗效,关闭率为73.0%～95.5%,且对肾脏、脑及消化道血流动力学影响显著减少.药物治疗无效且严重影响心肺功能者可选择手术治疗.     

Substance abuse in children and adolescents

Consumption of licit and illicit substances has increased all over the world and the age of initiation of abuse is progressively falling. The common drugs of abuse amongst children and adolescents in India are tobacco and alcohol. Use of illicit drugs like cannabis and heroin have also been reported. A high prevalence of drug use and even intravenous use among street children and working children is a matter of concern. Although initiation to drug use usually occurs during adolescence, the adolescent drug users are seldom seen in various treatment centres. Thus community based programmes are beneficial for prevention and treatment of substance abuse among children and adolescents.     

Conditions for rational drug treatment in childhood (author's transl)]

In pediatrics it is difficult to define indications of drug therapy, appropriate dosage and therapeutic reliability of drugs because experimental pharmacology in this age group has many obstacles. To provide information on optimal drug selection 83 pediatric clinics were asked to define their choice of drug treatment for particular purposes. The results were compared with an investigation of 1969. Trends of pediatric drug treatment during the last decade can be recognized.     

Drug related problems and <Emphasis Type="Italic">off-label</Emphasis> drug treatment in children as seen at a drug information centre

The aim of this work was to analyse the characteristics of Questions and Answers (Q&As) at a drug information centre (DIC) regarding drug related problems and off-label drug treatment in children. All questions concerning children 15 years or younger at a DIC in Stockholm, Sweden during the years 1995-2004 were analysed with respect to the main drug related problem, drug/s and drug group/s, whether the drugs were licensed or not, pediatric labelling of the drug/s and age and sex of the patient. Q&As were classified as whether or not they included evaluated literature information, adding to the labelling of the drugs. We identified 249 Q&As concerning pediatric drug treatment. Each question addressed an average of 1.5 drugs. More than two-thirds of the Q&As concerned adverse drug reactions and pediatric drug choice or dosing. Every second question was classified as off-label, psychotropic drugs being the most common. In half of all off-label Q&As, pediatric documentation on drug efficacy and safety outside the Swedish catalogue of medical products was found. Most Q&As concerned newborns and infants. However, the off-label proportion among questions was highest in adolescence as well as the evaluated literature information, adding to the labelling of the drugs. It was thus found that off-label drug treatment is common among pediatric questions at a DIC. This service can provide additional literature based information contributing to a safer use of drugs in children. There is still, however, a substantial need for clinical documentation of drug use in children.     

儿童癫癎对药物反应性与多药耐药基因MDR1C3435T多态性的相关性研究

目的:探讨汉族癫癎患儿MDR1基因单核苷酸多态性（C3435T）与对抗癫癎药物反应的相关性。方法：214例癫癎患儿根据对抗癫癎药物的反应性分为耐药组和对药物反应良好组,提取外周血基因组DNA,用PCR-RFLP的方法即多聚合酶链反应（PCR）扩增后继以限制性内切酶片断长度多态性（RFLP）分析,对不同药物反应性与基因型频率、等位基因频率结果进行分析。结果：214例可明确分型的病例中,对药物反应良好的有164例,耐药的有50例 。两组病例的等位基因频率比较和基因型频率相比较,均未发现差异有显著性。结论：该研究未能反映汉族儿童C3435T基因多态性与癫癎病例对药物反应之间的相关性。［中国当代儿科杂志,2007,9（1）：11-14］     

丙酸氟替卡松、孟鲁斯特钠、酮替芬治疗儿童咳嗽变异性哮喘的临床疗效观察

目的 观察丙酸氟替卡松（Flu）、孟鲁斯特钠（Mon）与酮替芬（Ket）的不同联合用药方案治疗儿童咳嗽变异性哮喘（CVA）的效果。方法 将2015年6月至2018年1月于呼吸科门诊收治的280例CVA患儿随机分为Flu+Mon+Ket组、Flu+Mon组、Flu+Ket组、Mon+Ket组、Flu组、Mon组、Ket组（n=40）。每组根据各自的用药方案给予相应药物,疗程均为3个月。评估患儿在治疗后2个月及3个月时的咳嗽情况及评分、肺功能和药物不良反应,并随访复发情况。结果 随治疗时间,7组患儿咳嗽评分均呈下降趋势,第1秒用力呼气容积占预计值的百分比（FEV1%）、最大呼气流量占预计值的百分比（PEF%）均呈上升趋势。治疗2个月后,Flu+Mon+Ket组咳嗽评分均低于其他组,FEV1%、PEF%均高于其他组（P < 0.05）;治疗2个月后及治疗3个月后,Ket组咳嗽评分明显高于其他组,FEV1%、PEF%明显低于其他组（P < 0.05）;其他各组在治疗3个月后,组间咳嗽评分、FEV1%、PEF%比较差异均无统计学意义（P > 0.05）。7组不良反应发生率低且差异无统计学意义（P > 0.05）。Ket组咳嗽复发率明显高于其他组（P < 0.001）,其他各组间咳嗽复发率比较差异无统计学意义（P > 0.0024）。结论 Flu、Mon、Ket三药联合使用治疗儿童CVA在2个月时的疗效较两药联用及单药使用显著,且用药安全;但用药3个月后,单用Flu或单用Mon的疗效不差于联合用药;单用Ket疗效不佳,且停药后复发率较高。     

Acute infectious diarrhoea in children: new insights in antisecretory treatment with racecadotril

In developing countries acute infectious diarrhoea remains one of the leading causes of death among young children, especially those under 1 year of age. In contrast, in industrialized nations the death rate is very low, although the disease is an important cause of morbidity and consumes substantial healthcare costs. A variety of viral, bacterial and parasitic organisms have been implicated in the pathogenesis of acute diarrhoea. The primary objectives of treatment of acute infectious diarrhoea are correction of dehydration with oral replacement therapy (ORT) and maintenance of good nutritional status via food intake. With regards drug therapy antimicrobial agents are not usually recommended since the disease is generally self-limiting. Racecadotril is powerful and selective enkephalinase inhibitor and has emerged as a promising drug in the antisecretory therapy of acute infectious diarrhoea in children. CONCLUSION: There is encouraging evidence that treatment with racecadotril can provide clinically relevant symptomatic relief by reducing the severity and duration of diarrhoeal episodes. The drug is well tolerated and has a favourable safety profile. However, further comparative studies and cost-effectiveness analyses are needed to define the position of the drug in the management of diarrhoeal illness in children.     

Substance abuse in adolescents: a complex conundrum for the clinician

Substance abuse remains a complex and pervasive conundrum for society and for clinicians seeking to improve the lives of their pediatric patients. Substance abuse is linked to the human instinct for pleasure at any cost and is fueled by enticing encouragement of the media teaching society to seek drug-induced pleasure without fear of negative consequences. Other complications are the limited education about psychoactive substances provided to youth and the health care profession pledged to serve them. Primary care clinicians must provide their adolescent patients with adequate screening and counseling about substance abuse. Treatment of the substance-abusing patient is often a combination of behavioral interventions (including family therapy), and, in limited situations, addiction-specific medications. Research suggests that female drug addicts have a better outcome in female-only drug treatment programs. In addition, new drugs are being developed that target specific brain mechanisms involved in drug addiction; these drugs will have less toxicity and less abuse potential than illicit drugs such as cocaine. Vaccines are being developed that will block the effects of such drugs as cocaine and PCP. Medications developed for the treatment of depression and epilepsy will be a source of medications for the treatment of drug addiction. The study of endorphins and the neurobiology of stress and substance abuse promise to develop potent anti-addiction chemicals, greatly aiding in the war on drug abuse.     

药物基因组学：指导常规用药的精准工具

药物基因组学是指导常规用药的新兴工具,其目的是通过药物作用（药效学）和药物浓度（药代动力学）相关基因的分析来提高药物治疗的有效性和安全性。目前需要将基因组数据整合到日常治疗的效益与风险评估之中,让因人而异的个体化治疗成为现实。同时走出尝试、观察和调整的传统框架,防止无效治疗,合理用量,规避药物不良反应。由于儿科患者的特殊性,药物基因组学对其影响更为广泛,并可加强医患之间的互信,提高药物治疗的依从性。希望临床医生勇于接纳迅速发展的药物基因组学,深入研究与祖先相关的基因变异,推动针对特殊族群的精准医学发展。通过在临床一线的应用,让患者能尽早地、更多地享受药物基因组学发展的成果。     

The potential of pharmacogenetics in the treatment of epilepsy.

Pharmacogenetics studies how genetic variants influence individual drug responses. Although pharmacogenetics is currently the subject of intensive research in several disease domains, it remains relatively unexplored in the field of epilepsy. Drug treatment of epilepsy is characterized by unpredictability of efficacy, adverse drug reactions and optimal doses in individual patients. Moreover, a substantial fraction of patients develop drug refractory epilepsy despite optimal treatment. Insights in the pathogenesis of epilepsy and the mechanisms of action of antiepileptic drugs (AEDs) have improved our understanding of the genetic determinants of AED response. The first reports in epilepsy pharmacogenetics are becoming available, and large-scale pharmacogenetic studies are now possible thanks to recent advances in genetics and decreasing genotyping costs. It is hoped that ultimately, findings in epilepsy pharmacogenetics will lead to a more efficacious and less harmful treatment of epilepsy, development of more effective AEDs and facilitation of clinical trials of new AEDs. However, although pharmacogenetics will undoubtedly improve our insight into the mechanisms underlying response to AEDs and perhaps into the pathogenesis of drug refractory epilepsy, clinical application of any findings is expected to be a long process, and considerable practical and theoretical hurdles need to be overcome before pharmacogenetic information will prove of any major utility in the clinical setting. This review addresses current knowledge on genetic factors contributing to AED response and discusses the potential of epilepsy pharmacogenetics in the clinical treatment of epilepsy and new AED development.     

Sulphasalazine desensitization in a paediatric patient with juvenile chronic arthritis

Sulphasalazine is an effective drug for the treatment of rheumatoid arthritis in adults. In paediatric patients, the drug has been used to treat inflammatory bowel disease and is currently under investigation for the treatment of juvenile chronic arthritis. Although sulphasalazine has a rather low incidence of serious side effects, one of the most common is skin rash, thought to be an allergic reaction. In adults, sulphasalazine desensitization programmes have proven to be effective for the treatment of this side effect. We present the case of a 7-year-old boy suffering from HLA-B 27 positive juvenile chronic arthritis. After initiation of treatment with sulphasalazine he developed an allergic skin rash, but tolerated the drug well after completion of a desensitization programme. To our knowledge, this is the first report of a paediatric patient with juvenile chronic arthritis successfully desensitized with sulphasalazine. Desensitization, juvenile chronic arthritis, sulphasalazine
J Kiimmerle-Deschner, Universitdtskinderklinik Tubingen, Rumelinstr. 19-23, 72076 Tubingen, Germany     

Difficulties in the treatment of scabies in infants

The risks of incidents and accidents--especially systemic ones--complicating topical scabies treatment in infants are reviewed. After a short review concerning insecticides (sulphur, benzyl-benzoate, DDT, Lindane, Crotamiton) and the use of several drugs proposed for infants, the authors insist on the choice of the drug and the therapeutic protocol, that are as important as the drug itself. Directions for use should be strict, in order to avoid automedication and overdosage. There is no study concerning the comparative evaluation of risks and efficacy of each drug.     

Antituberculous therapy in children

The advent of effective chemotherapeutic agents for the treatment of tuberculosis necessitates parallel emphasis in designing various short-course chemotherapy regimens in treating tuberculosis in children. Direct extrapolation from studies in adults is not appropriate because of differing pharmacokinetics and adverse drug reactions of antituberculous drugs in children. The pharmacological basis of antituberculous drugs and guidelines for using various drug regimens in relation to the varied clinical profile of tuberculosis in children have been discussed. It has been observed that the commonest type of tuberculosis in children is the pulmonary primary complex (71·4%), followed, by, progressive, primary disease (71·4%). Pleural effusion, bronchopneumonia and miliary tuberculosis are much less frequent. The 3 drug regimen does not seem to offer any advantage over the two drug regimen in the treatment of the primary pulmonary complex, as assessed by radiological clearance. Compliance is poorer in long-term and intermittent therapy as compared to short-course, continuous therapy. An erratum to this article is available at .     

Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in children: 20 years study in a tertiary care hospital

Background:Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe life-threatening skin conditions.The most common cause of these manifestations is medications.Beside discontinued of the culprit drug,systemic corticosteroids were used as a primary treatment option among pediatric population.This study aimed to explore causative drugs (drug group/ latent period),treaments,complications,and treatment outcome (morbidity,mortality,length of hospital stay) of SJS and TEN in children.Methods:A retrospective chart was reviewed during the period of 1992 to 2012 at Srinagarind Hospital,Faculty of Medicine,Khon Kaen University,Thailand.SJS and TEN were clinically diagnosed and confirmed by pediatric dermatologists.Other possible causes other than drug-induced SJS and TEN were excluded.Results:A total of 30 patients was recorded,including 24 (80％) SJS patients and 6 (20％) TEN patients.The mean age was 6.9 years (SD 4.4).Male to female ratio was 1.5:1.Antiepileptic drug group was the most common causative drug (n=18,60％),followed by antibiotic drug group (n=8,26.6％),and others (n=4,13.3％) which included nonsteroidal antiinflammtory drugs (NSAIDs) and chemotherapy drugs.Systemic corticosteroids were used in 29 patients (96.6％).Intravenous immunoglobulin was used in one TEN patient (3.3％).There was a medium correlation between time to treatment (systemic corticosteroids) and the length of hospital stay (Spearman correlation coefficient=0.63,P=0.005).Two TEN patients (6.6％) died.Conclusions:Carbamazepine was the most common causative drug of SJS and TEN in our study.The severity of skin detachment is not correlated to severity of ocular findings.However,the persistent of ocular complications up to one year is suggested for promptly appropriate ocular treatment in all SJS and TEN patients.Our data suggested that early administration of systemic corticosteroid may reduce the length of hospital stay and should be considered for the treatment of pediatric drug-induced SJS and TEN.