Prospective observational study of adverse drug reactions to diclofenac in children.

AIM: The aim of this study was to investigate the type of common (occurring in >1% of patients) adverse reactions caused by diclofenac when given to children for acute pain. METHODS: A prospective observational study was undertaken on paediatric surgical patents aged < or =12 years at Great Ormond Street and University College London Hospitals. All adverse events were recorded, and causality assessment used to judge the likelihood of them being due to diclofenac. Prospective recruitment meant not all patients were prescribed diclofenac, allowing an analysis of utilization. Causality of all serious adverse events was reviewed by an expert panel. RESULTS: Children prescribed diclofenac were significantly older, and stayed in hospital for shorter periods than those who were not. Diclofenac was not avoided in asthmatic patients. Data on 380 children showed they suffer similar types of nonserious adverse reactions to adults. The incidence (95% confidence interval) of rash was 0.8% (0.016, 2.3); minor central nervous system disturbance 0.5% (0.06, 1.9); rectal irritation with suppositories 0.3% (0.009, 1.9); and diarrhoea 0.3% (0.007, 1.5). No serious adverse event was judged to be caused by diclofenac, meaning the incidence of serious adverse reactions to diclofenac in children is <0.8%. CONCLUSION: Children given diclofenac for acute pain appeared to suffer similar types of adverse reactions to adults; the incidence of serious adverse reaction is <0.8%.

Minitablets: new modality to deliver medicines to preschool-aged children.

OBJECTIVE: The goal was to assess the acceptability and suitability of placebo minitablets for preschool-aged children. METHODS: One hundred children 2 to 6 years of age were recruited from a major London hospital. How to swallow the minitablet was discussed with the child, and chewing was discouraged. The parents were asked to administer 1 minitablet (placebo, 3-mm diameter) to the child. The outcomes were recorded as (1) swallowed, (2) chewed, (3) spat out, or (4) refused to take. RESULTS: Of the youngest children (2 years of age), almost one half (46%) swallowed the minitablet. The proportion increased to 53% for children 3 years of age. Children > or =4 years of age were more likely to swallow the minitablet than not to swallow the minitablet, with 85% of 5-year-old children swallowing the minitablet. The ability to swallow the minitablet was not affected by gender. CONCLUSIONS: This study demonstrated the potential to use minitablets for the treatment of preschool-aged children and suggests that minitablets can be used as a potential new formulation for children in this age range.

National Patient Safety Agency: improving patient safety across all critical care areas.

The National Patient Safety Agency (NPSA) reviews patient safety incidents throughout the National Health Service (NHS) in the United Kingdom and aims to initiate preventative measures. Recent alerts include injectable medication, oral syringes for enternal administration, preventing hyponatraemia in children and anticoagulation. This article gives an insight into the rationale and steps currently being undertaken to respond to these recommendations.

Rasburicase in the prevention and treatment of tumour lysis syndrome.

Tumour lysis syndrome (TLS) can be a life threatening complication of cancer therapy where cells undergo overwhelming lysis. The result is a pattern of metabolic abnormalities leading to acute renal failure and possible coagulopathy. Prophylactic pharmaceutical interventions can prevent this syndrome in almost all patients reducing possible admission to the intensive care unit. This article reviews the clinical efficacy, side effect profile, dosing and administration of rasburicase, an intravenous recombinant urate oxidase used in patients at risk of Tumour lysis syndrome due to a high tumour burden or where treatment is required. Rasburicase is an expensive but effective treatment option in the prevention and treatment of tumour lysis syndrome.

Caspofungin in the treatment of invasive fungal infections.

Caspofungin is a member of a new class of antifungals called Echinocandins and is the first to have marketing authorisation in the United Kingdom. This article reviews the clinical efficacy, side effect profile, dosing and administration schedule of caspofungin. The article also discusses the warnings and precautions associated with the use of this drug. Caspofungin is an effective treatment option in the management of fungal infections.

Voriconazole in the treatment of invasive fungal infections.

Fungal infections in immunocompromised patients in the Intensive Care Unit (ICU) are a major cause of mortality and morbidity and can lead to extended stays on the ICU. New antifungal drugs have been developed to increase treatment options to improve the clinical outcome. This article reviews the clinical efficacy, side effect profile, dosing and administration schedule of voriconazole, a recently launched second generation triazole. The article also discusses the warnings and precautions associated with the use of this drug. Voriconazole is an effective treatment option in the management of fungal infections.

Ibuprofen in the management of neonatal Patent Ductus Arteriosus.

Patent Ductus Arteriosus (PDA) has a prevalence of approximately 25% in neonates of less than 33 weeks gestation. Failure to treat increases the mortality risk in these preterm infants. Intravenous Ibuprofen has recently been licensed in the United Kingdom as a treatment for this condition. This article reviews the clinical efficacy, side effect profile and dosing/administration schedule of this drug and discusses the warnings and precautions currently attributed to this formulation. Ibuprofen provides a further option for neonatologists in the management of PDA.