Pharmacists' attitudes towards pediatric cough and cold products and behind the counter status.

BACKGROUND: Safety and efficacy issues regarding over-the-counter cough and cold (CAC) products for use in children have surfaced. Late in 2007 the FDA began reviewing CAC product status for use in children under 6 years old. OBJECTIVE: In regards to CAC products for children < 6 years old, to determine pharmacists: 1) comfort level in recommending; 2) attitudes towards behind-the-counter (BTC) status; and 3) level of support for BTC status. An additional objective was to determine how frequently pharmacists were asked for CAC product recommendations for children METHODS: Georgia Pharmacy Association members (2,045) were invited to anonymously participate in a self-administered online survey from January 3 - Feb 6, 2008. Topic areas included demographics, comfort in recommending CAC, and BTC status. RESULTS: Most responding pharmacists (99.1%) feel pediatric CAC medicine safety problems are due to inappropriate use. More than 50% of chain and independent pharmacists were asked to recommend CAC medicines for children during cold/flu season once a day or less, and 79% reported counseling on less than 50% of total CAC sales. The majority of pharmacists felt comfortable recommending CAC medications when thinking of both safety and efficacy. Most pharmacists supported a BTC condition of sale for children under two for decongestants, antihistamines, and antitussives, and for decongestants and antitussives for children between 2 and 5 years old. CONCLUSIONS: Most pharmacists indicate comfort in recommending CAC despite lack of evidence for safety or efficacy and support BTC status. Pharmacist education on this topic would be useful.

The Use of Daptomycin and Linezolid to Treat Vancomycin-Intermediate Staphylococcus haemolyticus Infection in a Premature Infant.

Infections with staphylococcal species, especially coagulase-negative staphylococci are common after neurosurgical procedures. We report a case of a coagulase-negative staphylococci infection of a ventricular shunt site in a 105-day-old, premature infant born at 25 weeks gestation with multiple medical problems. The patient was successfully treated with a combination of daptomycin and linezolid for the persistent infection, which was increasingly resistant to vancomycin. The patient was initially treated with a combination of vancomycin and rifampin; however, the course of therapy had to be changed when the bacteria was identified as having intermediate resistance to vancomycin. Therapy was initially changed to linezolid monotherapy, but culture results continued to be positive for the bacteria, necessitating removal of an external ventricular drain and combination therapy of daptomycin and linezolid for 2 weeks before insertion of a new ventricular shunt. The patient received 4 weeks of therapy with no further positive results of the culture analysis. To our knowledge, this is the first published case report of the use of daptomycin to successfully treat a central nervous system infection in a premature infant.

Quality experiential education.

The 2007 Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards and Guidelines for the Professional Program in Pharmacy delineate new expectations for experiential education within curricula and include guidance on the development and conduct of Pharmacy Practice Experiences. The American College of Clinical Pharmacy (ACCP) Educational Affairs Subcommittee C developed a position statement to further delineate the views of ACCP on factors necessary to meet contemporary standards for doctoral education in pharmacy and to provide guidance to our membership on how to implement the new standards. This White Paper provides explanation and supporting documentation for positions on quantitative and qualitative aspects of experiential education, as well as requirements for practice sites, preceptor roles, qualification, credentialing, and development and assessment of student performance.

Survey of the use of corticosteroids among neonatal intensive care units for the prevention or treatment of bronchopulmonary dysplasia.

OBJECTIVE: To survey neonatal intensive care units (NICUs) at academic medical centers to determine the current use of inhaled and systemic corticosteroids for the prevention or treatment of bronchopulmonary dysplasia (BPD). METHODS: A survey was developed to evaluate aspects of systemic and inhaled corticosteroid use in neonates. Eighty academic medical centers with neonatal/perinatal medicine fellowship programs were surveyed. Neonatology fellows or NICU clinical pharmacists with direct patient care activities responded via telephone, fax or e-mail. RESULTS: Fifty-three institutions responded to the survey (66.3% response rate). Twenty-nine percent of respondents (n = 15) use corticosteroids for prevention of BPD. Systemic corticosteroids are used by 6% of respondents (n = 3) and inhaled corticosteroids are used by 14% of respondents (n = 7) for prevention. Ten percent of respondents (n = 5) use either systemic or inhaled corticosteroids for prevention. Eighty-eight percent of respondents (n = 45) use corticosteroids for treatment of BPD. Systemic corticosteroids are used by 10% of respondents (n = 5) and inhaled corticosteroids are used by 10% of respondents (n = 5) for treatment. Sixty-nine percent of respondents (n = 35) use either systemic or inhaled corticosteroids for treatment. There was a wide variability in drug, dose, titration, taper, administration, and duration of therapy reported. CONCLUSIONS: These results indicate that systemic and inhaled corticosteroids are commonly used by practitioners for the prevention or treatment of BPD despite a recommendation against the routine use of systemic corticosteroids by the American Academy of Pediatrics' (AAP) Committee on Fetus and Newborn and the Canadian Paediatric Society's Fetus and Newborn Committee from February 2002.