An Evaluation of the Appropriateness of Initial Enoxaparin Dosing Among Pediatric Patients.

Background Enoxaparin is a low molecular weight heparin that irreversibly inactivates factor Xa leading to the inhibition of clot formation. Despite the non-FDA approval in pediatrics, enoxaparin is recommended with an initial dose of 1.5mg/kg/q12hrs for patients aged ≤ 2 months and 1mg/kg/q12hrs for patients > 2 months, targeting therapeutic anti-Xa with a range of 0.5 to 1 units/mL. Due to more rapid clearance in pediatrics, our study aims to assess the need for initial higher doses than recommended by the guideline to reach the target anti-Xa level. Methods A retrospective chart review of all pediatric patients under all specialties who were treated with enoxaparin either in inpatient or outpatient settings between February 2021 and June 2022 at children's specialized hospital and meet the inclusion criteria, including age ≤ 15 years old and treated with enoxaparin with initial dose according to the American College of Chest Physicians (CHEST) guideline, while patients who received prophylaxis doses did not have anti-Xa levels or creatinine clearance < 30 mL/min/1.73m2 were excluded. Demographic data, laboratory data, and enoxaparin dosing were all collected to assess whether the initial enoxaparin dose will result in a therapeutic level as a primary endpoint and secondary endpoints including the average enoxaparin dose required to achieve the therapeutic level and to report any side effects. All data were entered and analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25, Armonk, NY), and all categorical variables were reported as frequency and percentage while continuous variables expressed as mean ± SD and the study was approved by our research center institutional review board (IRB). Results Thirty patients were included in the study (17 males), 10 patients were aged ≤ 2 months, four were between 3 and 12 months and 16 were > 12 months, most of the patients received enoxaparin for deep vein thrombosis. In the majority of patients (76.7%), the initial dose failed to achieve the target anti-Xa while a mean dose of 2 mg/kg/q12hrs in patients ≤ 2 months, 1.7mg/kg/q12hrs in patients 3-12 months and 1.3 mg/kg/q12hrs in patients > 12 months was sufficient to reach the target level. After achieving a therapeutic anti-Xa level, only one patient experienced major bleeding while four patients experienced minor bleeding, no edema or thrombocytopenia were reported. Conclusion In conclusion, initiating enoxaparin according to the recommended dose by the guideline failed to achieve target anti-Xa in the majority of patients which necessitates starting enoxaparin with initial higher doses according to the patient's age to provide more prompt achievement of target anti-Xa.

Early oral switch to combined cefixime therapy for management of osteoarticular infections in pediatric sickle cell disease patients: A descriptive analysis.

BACKGROUND: The treatment of osteoarticular infections in pediatric patients with sickle cell disease (SCD) is a challenging task for the practitioner. The aim of this study is to evaluate cefixime for the treatment of osteoarticular infections in pediatric SCD patients by retrospective design. METHODS: This study was done in the pediatric hospital of King Saud Medical City, Riyadh, Saudi Arabia. The data was obtained from medical records of patients aged 1-16 years admitted between January 2019 to December 2020, diagnosed with SCD and received cefixime for the treatment of OI. A descriptive study for pediatric patients admitted between January 2019 to December 2020 diagnosed with sickle cell disease and diagnosed with osteoarticular infection. All patients were treated with cefixime. Medians and interquartile ranges (IQRs) were used for the descriptive analysis. RESULTS: A total of 260 patients were screened, and 51 cases [osteomyelitis (OM), n = 43, and septic arthritis (SA), n = 8] met the inclusion criteria. The median age of OM patients was 7 years, with males making up 67.4% of the cohort. The median length of IV antibiotics and hospital stays were 10 days and 11 days, respectively. The median total duration of antibiotic use was 37 and 25 days for OM and SA, respectively. The treatment success rate was 88% in OM cases and 100% in SA patients. Readmission was noted in 39.5% of the OM patients, while only 25% of the SA patients were recorded for reinfection. CONCLUSION: The study's findings revealed that Cefixime is a viable oral alternative for treating osteoarticular infection in pediatric SCD patients. Nonetheless, a prospective investigation is required to corroborate the findings of this study.

Postpartum prophylaxis of venous thromboembolism with anticoagulation: A case report.

Although there is a remarkably high risk of venous thromboembolism (VTE) during pregnancy and postpartum, a cautious approach is needed while initiating therapeutic and prophylactic anticoagulant therapy. The merits of heparin for thromboprophylaxis in postpartum patients are exaggerated, and its risk is generally overlooked. This study aimed to report the inappropriate use of anticoagulants in postpartum patients. The patient in this report was a 31-year-old healthy woman who had had a normal spontaneous vaginal delivery and visited the hospital a 3-day history of small itchy blisters at the enoxaparin injection sites. An examination revealed class II obesity. The Naranjo Scale assessment showed the possibility of an enoxaparin-induced hypersensitivity reaction. The clinical care team decided to discontinue the heparin. A follow-up examination did not show any signs of VTE. Although many pregnant and postnatal women might need VTE prophylaxis, routine anticoagulation for such a population is not essential. Clinicians should weigh the risks versus benefits to avoid any adverse drug reactions that may occur with this class of medication.

Safety and Efficacy of Daptomycin in Neonates with Coagulase-Negative Staphylococci: Case Series Analysis.

There has been an increase in the prevalence of gram-positive bacteremia in neonates in the last two decades. However, as a consequence of better care, there has been an increase in the survival of premature neonates. Coagulase-negative staphylococci (CoNS) is the most prevalent bacteria, responsible for up to 60% of late-onset sepsis (LOS). Daptomycin, a lipopeptide antimicrobial agent, is active against CoNS. This was an observational, retrospective case series study carried out in the Pediatric Hospital of King Saud Medical City, Riyadh, Saudi Arabia. The medical records of 21 neonates, aged 0-28 days, who were treated in Neonatal Intensive Care Unit (NICU) with intravenous daptomycin as monotherapy or combination therapy for at least 4 days for proven gram-positive infection between June 2019 to July 2020, were included. The median gestational and chronological age were 27 weeks and 5 days, respectively. The most frequent diagnosis in neonates was infective endocarditis (42.9%). Of the 21 patients who received daptomycin therapy, 13 (62%) recovered and 8 died. The clinical cure rate was higher in Staphylococcus hominis (100%) and in patients who received 6 mg/kg/dose twice daily (62.5%). The mean of aspartate aminotransferase significantly elevated after starting daptomycin (p = 0.048). However, no muscular or neurological toxicity of daptomycin was documented in any of the cases. Overall, daptomycin was well tolerated, even with long-term treatment.

Congenital brucellosis: A case report.

Although rare, brucellosis is endemic in the Kingdom of Saudi Arabia (KSA). In the case presented here, a neonate was born at 29 weeks gestation with severe respiratory depression, pyrexia; hypotension and an elevated white blood cell count. Her mother was a 19-year-old pregnant woman who developed premature rupture of the membranes and went into labour early. Sepsis was suspected and so the neonate received dobutamine and empiric ampicillin/gentamicin. The mother reported visiting a farm during her pregnancy and so congenital brucellosis was considered a possibility. Blood cultures were positive for Gram-negative coccobacilli and serology confirmed the presence of Brucella abortus and B. meltiness. Antibiotic treatment was changed to rifampin/gentamicin/ciprofloxacin but on day 17 the baby deteriorated and gentamicin was discontinued and meropenem was added. The neonate gradually improved; meropenem was discontinued on day 24 and the baby was discharged from hospital on day 38.

Cefdinir associated bloody stool in Riyadh infant: A case report.

Cefdinir is one of the broad spectrum cephalosporin used as a replacement to amoxicillin in allergic pediatric population. There are reports of forming red stool in patients receiving cefdinir along with iron or iron containing preparations. This is a benign interaction and wane upon completion/discontinuation of cefdinir therapy. This case report describes a 6-month-old boy whose parents were distressed when they found reddening of their ward's diaper while taking cefdinir in presence of iron supplements.