Advances in pediatric drug therapy of asthma.

Most pediatric patients requiring medication to prevent or treat asthmatic symptoms require only the use of inhaled beta 2 agonists. Children younger than 6 years old usually require use of the nebulized or oral forms of beta 2 agonists. Theophylline or cromolyn is added as a second-line agent to the regimens of children who need an additional agent. Anticholinergic agents are added as third-line agents for resistant cases of asthma. Inhaled and oral steroids are reserved for resistant cases of childhood chronic asthma, even though adults frequently are given inhaled steroids as second-line agents. Parenteral steroids are used for the treatment of status asthmaticus.

Antifungal agents and their renal implications in the neonate.

The incidence of superficial or systemic fungal infections has been increasing in neonates. The cause of this increased susceptibility to fungal infections is due to the increased use of mechanical ventilation, indwelling catheters, broad-spectrum antibiotic therapy, parenteral nutrition, and steroid therapy. The most common organism encountered in neonatal infections is Candida species. This article will cover the etiology, signs, symptoms, diagnosis, and treatment of the usual neonatal fungal infections. Each of the antifungal agents used to treat neonates will be discussed with regard to its mechanism of action, pharmacokinetics, indications, normal and renal functional impairment dosing, and adverse effects.

Treatment of nontuberculous mycobacterial infections in pediatric patients.

Two cases of Mycobacterium avium-intracellulare complex (MAC) infections are described, and the diagnosis, clinical features, and management of MAC infections are reviewed. In case 1, a four-year-old boy was diagnosed as having both acquired immunodeficiency syndrome (AIDS) and disseminated MAC infection. He was treated with a combination of isoniazid, ethambutol hydrochloride, rifabutin, and clofazimine. Results of susceptibility testing showed that the MAC was susceptible to rifabutin and ethambutol with intermediate susceptibility to isoniazid. The child developed severe adverse effects that necessitated the discontinuation of rifabutin therapy. Despite therapy, blood cultures remained positive for MAC. The child died of disseminated human immunodeficiency virus and MAC infection. In case 2, a 20-month-old girl was found to have a prevertebral retropharyngeal mass caused by MAC. The child did not have evidence of immunologic deficiency. She was treated with streptomycin, ethambutol, clofazimine, and rifabutin. Streptomycin was discontinued after three months. After seven months the mass decreased in size, allowing for surgical resection. Intraoperative cultures were negative for mycobacteria. Ethambutol, rifabutin, and clofazimine were continued for a total of 12 months, at which time the child was determined to be clinically and radiologically cured. Empiric multidrug antituberculous therapy should be initiated in patients with suspected disseminated nontuberculous mycobacterial infection because final isolation, identification, and susceptibility testing may take several weeks. Clofazimine and rifabutin, in combination with isoniazid and ethambutol, may be useful in the treatment of some MAC infections. At least four drugs are given, and regimens often consist of six drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient-care unit system for measuring clinical and distributive pharmacy workload.

A time-weighted measurement of workload for distributive and clinical pharmaceutical services, the Patient-care Unit (PCU) System, is described. The Department of Pharmaceutical Services and the School of Pharmacy at the University of California, San Francisco, defines each patient-care pharmaceutical activity and assigns it a weighted value (WPCU) based on the time required to complete the activity. Manpower requirements are based on WPCUs and records of activities performed. Forty-two WPCUs have been defined. Based on these units, the PCU System permits (1) determination of pharmacy time devoted to distributive and clinical pharmaceutical services, (2) evaluation of staffing requirements for existing or proposed programs, (3) measurement of departmental productivity, and (4) comparison of pharmaceutical services offered in different hospitals. Applications and limitations of the PCU concept, which has been adopted by nine other hospitals, are discussed. The PCU System is a step toward development of a uniform workload reporting system for hospital pharmacies.

Bleeding gastric varices and gastric torsion secondary to a wandering spleen.

We are reporting a patient who presente with upper gastrointestinal bleeding which was in part caused by a wandering spleen. Endoscopy revealed erosions of gastric varices in the presence of gastric torsion. At surgical exploration the spleen was present in the pelvis. The twisted and elongated splenic pedicle resulted in a markedly dilated venous system of the proximal stomach and the engorged spleen. The literature of the wandering spleen is reviewed.