Use of cidofovir with extracorporeal membrane oxygenation to treat adenovirus-associated acute respiratory distress syndrome in paediatric patients- a case series.

WHAT IS KNOWN AND OBJECTIVE: Reports of cidofovir dosing with extracorporeal membrane oxygenation (ECMO) support are limited. This case series describes our clinical experience and provides a literature review regarding cidofovir dosing in paediatric patients requiring ECMO support. CASE SUMMARY: Three patients with adenovirus-associated acute respiratory distress syndrome (ARDS) were treated with cidofovir while requiring ECMO support. A 27-month-old patient was treated with cidofovir 1 mg/kg/dose three times weekly, and a 19-month-old patient and an 18-year-old patient were treated with cidofovir 5 mg/kg/dose weekly. WHAT IS NEW AND CONCLUSION: This case series describes the dosing and positive clinical response of cidofovir in paediatric patients with adenovirus-associated ARDS requiring ECMO support.

Clinical Experience with Daptomycin in Pediatrics.

INTRODUCTION: The management of gram-positive infections has been complicated in recent years by the emergence of antimicrobial resistance, leaving fewer options for therapy. Daptomycin is a lipopeptide antibiotic used for the systemic treatment of gram-positive infections. It has a distinct mechanism of action and a favorable side effect profile, and it requires once/day dosing. Unfortunately, there is a paucity of safety, efficacy, and pharmacokinetic data in neonatal and pediatric patients. The objective of this study was to review our experience with daptomycin use for the treatment of gram-positive infections in these patient populations. METHODS: We conducted a retrospective analysis of electronic medical records of hospitalized children who received daptomycin between October 2008 and June 2014 for the treatment of proven gram-positive infections. RESULTS: Of the 146 patients who received at least 3 days of daptomycin therapy, 109 patients had a proven gram-positive infection and were included for further analysis. Of the 109 patients, 71 were males (65%) and the median age was 12 years (range: 2.5 mo to 24 yrs). The median duration of therapy was 12 days (range: 3-121 days; mean = 16 days). Catheter-related bloodstream infections were the most common type of infections (n=81 patients) in those receiving daptomycin treatment. One hundred seven patients (98%) had documented improvement and resolution at the time of hospital discharge. One hundred four patients (95%) had a baseline creatine phosphokinase (CPK) level obtained. Of these 104 patients, 48 (46%) had at least one follow-up CPK level after the start of therapy. Three patients' charts showed laboratory evidence of elevated CPK values. CONCLUSIONS: The majority of patients demonstrated clinical improvement after receiving daptomycin as primary therapy for proven gram-positive infections. Larger randomized controlled trials focusing on safety and efficacy are necessary to assess these outcomes with daptomycin use in the pediatric population.

Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative.

OBJECTIVES: Adverse drug events (ADEs) occur more frequently in pediatric patients than adults. ADEs frequently cause serious harm to children and increase the cost of care. The purpose of this study was to decrease ADEs by targeting the entire medication-delivery system for all high-risk medications. METHODS: Thirteen freestanding children's hospitals participated in this ADE collaborative. An advisory panel developed a change package of interventions that consisted of standardization of medication-ordering (eg, consensus-based protocols and order sets and high-alert medication protocols), reliable medication-dispensing processes (eg, automated dispensing cabinets and redesign of floor stock procedures), reliable medication-administration processes (eg, safe pump use and reducing interruptions), improvement of patient safety culture (eg, safety-culture changes and reduction of staff intimidation), and clinical decision support (eg, increase ADE detection and redesign care systems). ADE rates were compared from the 3-month baseline period to quarters of the 12-month intervention phase. ADE rates were categorized further as opioid related and other medication related. RESULTS: From baseline to the final quarter, the collaborative resulted in a 42% decrease in total ADEs, a 51% decrease in opioid-related ADEs, and a 41% decrease in other medication ADEs. CONCLUSION: A pediatric collaborative that targeted the medication-delivery system decreased the rate of ADEs at participating institutions.