Showing posts with label pharmaceuticals. Show all posts
Showing posts with label pharmaceuticals. Show all posts

Wednesday, September 16, 2015

Dexamethasone for Septic Arthritis? Does It Make a Difference?


By: Lewis First, MD, MS; Editor-in-Chief         
 
       We can all note the benefits of using dexamethasone in a number of disease processes, but how many of us think about it when a child presents with a septic joint?  Fogel et al. (doi: 10.1542/peds.2014-4025) opted to study the effect of dexamethasone in combination with antibiotics in hospitalized children at one pediatric center.   
      While not randomized, 26 of the 116 patients with septic arthritis got antibiotics and dexamethasone. There were not striking differences in the demographics of who did and did not get the steroid. Yet when children received dexamethasone in this study, there were marked clinical improvements including shorter duration of fever, faster clinical improvement, quicker drop in C-reactive protein as a marker of inflammation and others including a shorter hospital stay. 
      Just how much dexamethasone to use, and what if any side effects occurred, as well as lots of other interesting information about this newer usage of a steroid in combination with antibiotics awaits your perusal by linking to this study being released this week.  Have you used dexamethasone in the care of your patients with septic arthritis? If so, tell us about it by responding to this blog, sending us an e-letter, or posting your comments on our Facebook or Twitter sites.


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Monday, July 20, 2015

Are Parental Requests for Antibiotics for Their Children Decreasing Over Time? New Survey Doses Out Some Interesting Findings

By: Lewis First, MD, MS; Editor-in-Chief  

          With the rise in antibiotic resistance over the past few decades, there has been an increased effort by all of us to become stricter in our use of these antimicrobials—but have those efforts paid off?  Vaz et al. (doi:10.1542/peds.2015-0883) opted to study this question by surveying 1500 parents of children less than 6 years of age to determine their knowledge and attitudes toward use of antibiotics.  The authors divided respondents in terms of their insurance status as being in Medicaid managed care or a commercial health plan. The results are worth reading and thinking about.  For example, while we’ve made some headway in more parents recognizing that green nasal discharge does not require a prescription for an antibiotic, the improvement is less visible amongst Medicaid-enrolled families who continue to request that unnecessary antibiotics be prescribed.  There are many other variables identified that may be causing parents to request unneeded antibacterial medication, and the authors do a nice job of identifying them in their study.
          So what does this study mean for your practice?  Do you agree that your patient education efforts have been in vain when it comes to reducing their requests for antibiotics in likely viral scenarios, or have you succeeded where this study has not?  Doctor Sharon Meropol and Doctor Mark Votruba (doi: 10.1542/peds.2015-1780) add their opinion in an accompanying commentary to this study that you should turn to after reviewing the published data, but just as importantly, we would love to hear your thoughts and ideas on what works when it comes to educating families and changing their antibiotic-seeking behavior by responding to this blog, sending us an e-letter or posting your thoughts on our Facebook or Twitter websites.  

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Friday, May 8, 2015

The Pharmacy as a Measure of the Health of Asthmatics in the Community: A New Metric Worth Considering

By: Lewis First, MD, MS; Editor-in-Chief    
 

          We are always looking for ways to improve the health of populations and the population of asthmatics in a given community can certainly vary in their utilization of health care resources (ranging from routine visits to exacerbations requiring usage of emergency or inpatient resources).  Wouldn’t it be helpful to have a measure that might indicate if the patients with asthma in your community are at risk for getting worse so you might intervene sooner than later to make sure they are complying with their asthma action plans?   Beck et al. (doi: 10.1542/peds.2014-3796) share with us this week in an early-released study how medication data from a chain of pharmacies in one county can determine a higher or lower utilization rate of emergency visits and inpatient admissions.  The authors define the “Pharmacy-level Asthma Medication Ratio (Ph-AMR) as the number of controller fills divided by the number of controller and rescue fills.  The higher the ratio, the more the controller is being utilized relative to rescue medications.  The outcome measure associated with the use of the ratio was the number of emergency visits and admissions divided by the number of asthmatic children in that county served by the 27 pharmacies it contained.   The authors did their best to control for confounders like poverty status and access to care. 
As to results, every 0.1 increase in the ratio resulted in a proportional decrease in emergency visits and hospitalizations.  This is a unique way to think about monitoring the health of the population and may prompt you to share the results with your neighborhood pharmacist to see if they can provide a similar metric on a periodic basis to you so that increased utilization might be curtailed with targeted interventions for those areas of your community served by pharmacies with lower Ph-AMR ratios.  To help you make sense of the importance of thinking about the health of populations and not just individual patients with asthma, check out the commentary written by Dr. Louis Vernacchio (doi: 10.1542/peds.2015-0809) who provides an interesting perspective on the implications of this study.  You’ll breathe easier thinking about ways to improve the monitoring of asthmatics in your community if you read this study and consider forming stronger interprofessional ties with the pharmacies you most rely upon to help insure the health of the population you serve.

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Tuesday, April 21, 2015

A Bitter Pill to Swallow: What Does the Pediatric Literature Say About Effective Pill-Swallowing Interventions?

By: Lewis First, MD, MS; Editor-in-Chief  

      Every one of us that sees patients comes across a child who will not take the
Amanda Mills phil.cdc.gov
medicine we prescribe or recommend—perhaps due to taste, perhaps because they cannot take a pill easily, or perhaps just to be oppositional.  We also often make recommendations to try to get children to be better at taking their medicine—but what is the evidence that what we recommend works? 

      Patel et al. (doi:10.1542/peds.2014-2114) dose out the results of a systematic review on this topic this week in our journal.  The authors look at studies over a 27 year span and sadly only find 4 cohort studies and one case series—all of which recommended a method found successful in that individual study. The fact that there may be limited generalizability of a particular intervention studied, or some potential bias in wanting an assessment to work are but some of the limitations identified in this interesting review.  So what method do you recommend? 
      Is it discussed in this study?  We want to hear from you on this review and any tricks you have found (evidence-based or anecdotal) that you can share with us by responding to this blog, sending us an e-letter or posting on our Facebook and Twitter pages.  

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Friday, March 27, 2015

Pimecrolimus Does More than Just Skin the Surface When It Comes to Treating Atopic Dermatitis


By: Lewis First, MD, MS; Editor-in-Chief  
 
While our first line of treatment for moderate to severe atopic dermatitis in a child usually involves the use of a topical corticosteroid, steroids, especially the more potent ones, may also have some side effects. As a result, some parents of infants may be concerned about using topical steroids, reducing compliance with this mode of therapy.  Fortunately, other therapies have entered the treatment market, offering non-steroidal immunomodulatory effects to reduce the degree of inflammation—but how safe and effective are these drugs? 
Sigurgeirsson et al. (doi: 10.1542/peds.2014-1990) opted to answer this question by studying one immunomodulatory drug—pimecrolimus—in a 5-year randomized controlled open-label trial comparing this drug to mild to moderate topical corticosteroids, using one or the other until the flare resolved and reusing the same medication when a flare recurred.  While short-term topical steroids were also added to pimecrolimus for more severe disease flares in that group, the results are nonetheless very impressive.  The infants who received pimecrolimus had substantially less need for topical steroids during flares than the other group who used them exclusively for flares and the number and quality of adverse events in both groups were minimal and nonsubstantial. Most importantly, there was no change in humoral or cellular immunity in either group.
If you are faced with the need for long-term management of an infant or young child with atopic dermatitis, this study may make the use of pimecrolimus a more rash-ional choice than you may have considered and perhaps move it into first-line treatment for mild to moderate atopic dermatitis in our patients.  So are you using pimecrolimus as your first line?  Share your responses with us either via this blog, an e-letter or our Facebook or Twitter sites.

Related Links:

  •        Vitamin D Deficiency Rickets in an Adolescent With Severe Atopic Dermatitis
  •         Grand Rounds: Nutrient Supplementation and Atopic Dermatitis