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Biomedical subjects

I Choonara

Publications and source records attributed to I Choonara.

At least 55 records · Page 3Linked to original sources
PubMed1998

Unlicensed and off label drug use in paediatric wards: prospective study.

OBJECTIVE: To determine the extent of use in children in hospital of drugs that are not specifically licensed for use in children (unlicensed) and of drugs that are used outside the terms of their product licence that apply to indication, age, dose, or route of administration (off label). DESIGN: Prospective study of drugs administered on paediatric medical and surgical wards for 13 weeks. SETTING: Regional children's hospital. SUBJECTS: Paediatric inpatients in medical and surgical wards. MAIN OUTCOME MEASURES: Comparison of the use of each drug with its product licence to determine whether the drug was used in an unlicensed or off label manner. RESULTS: 2013 courses of drugs were administered to 609 paediatric patients in 707 admissions. 506 (25%) of the drug courses (prescriptions) were either unlicensed (139) or off label (367) uses. In 256 (36%) of the 707 admissions patients received one or more courses of an unlicensed or off label treatment in hospital. CONCLUSIONS: Use of drugs in an off label or unlicensed manner to treat children is widespread. Drugs are more likely to be used in an off label manner than in an unlicensed manner.

Adolescent↗
PubMed1998

Parental anxiety due to abnormal behaviour following withdrawal of sedation.

Abnormal behaviour has been previously reported on withdrawal of sedation in critically-ill children. This description of a child who had prolonged withdrawal symptoms lasting almost 2 weeks includes a report on his parent's comments in relation to the anxiety they felt while he was behaving abnormally. Health professionals need to be aware of the severe nature of this withdrawal reaction and its effect on the parents.

Adult↗
PubMed1998

Induction of CYP1A2 activity by carbamazepine in children using the caffeine breath test.

AIMS: Carbamazepine is a known enzyme inducer. The aim of this study was to determine whether carbamazepine induces the metabolism of caffeine in children. METHODS: Children due to receive carbamazepine for epilepsy were recruited into the study. The caffeine breath test was carried out prior to the administration of carbamazepine and after a minimum of 2-3 weeks therapy. Five children were studied and they received 200-600 mg carbamazepine daily. RESULTS: The mean values of the 2 h cumulative labelled carbon dioxide were 3.47% before and 7.65% during carbamazepine. There was a significant increase in the percentage labelled caffeine exhaled as carbon dioxide during the administration of carbamazepine (Student's paired t-test, P < 0.05). CONCLUSIONS: The results suggest that carbamazepine induces the metabolism of caffeine by the CYP1A2 pathway in the children studied.

Adolescent↗
PubMed1997

Lack of inhibitory effect of cimetidine on caffeine metabolism in children using the caffeine breath test.

AIMS: To study the potential drug interaction between cimetidine and caffeine in a group of children who received cimetidine for gastritis. METHODS: The caffeine breath test was carried out prior to the administration of cimetidine and after 2-3 weeks therapy. The children (n = 1) received 300-800 mg cimetidine daily (11-36 mg kg(-1) day(-1)). RESULTS: There was no significant change in the 2 h cumulative labelled CO2 following the administration of cimetidine (mean values 5.61% before and 4.87% during cimetidine; Student's t-test P > 0.2). CONCLUSIONS: Cimetidine did not have an inhibitory effect on the metabolism of caffeine in this group of children studied.

Adolescent↗
PubMed1997

A randomized controlled trial of sedation in the critically ill.

A randomized controlled trial comparing: a) a combination of oral chloral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was carried out. The level of sedation was assessed four hourly using a specifically devized sedation scale. Forty-four children entered the study of whom two were subsequently excluded. The number of satisfactory assessments (desired and actual levels of sedation equal) was significantly greater in the chloral hydrate and promethazine group (Chi-squared P < 0.01; confidence intervals of the difference 0.06 to 0.20). The number of assessments at level 5 on the sedation scale (patient restless/ distressed) was significantly greater in the midazolam group (Chi-squared P < 0.05). The total number of satisfactory assessments in the two groups were only 61 and 48% respectively, suggesting that sedation can be considerably improved. Chloral hydrate and promethazine are more effective than midazolam as maintenance sedation in critically ill children. It is possible to prospectively study the efficacy of sedative drugs in critically ill children.

Administration, Oral↗
PubMed1997

Enhanced drug metabolism in young children with cystic fibrosis.

The effect of cystic fibrosis on caffeine metabolism was studied in young children using the caffeine breath test. Eight children with cystic fibrosis aged 2-6 years and nine age matched controls were studied on a single occasion, and the cumulative percentage of labelled caffeine exhaled as carbon dioxide measured over two hours. This was significantly higher in the patients with cystic fibrosis than in controls, suggesting an increase in the CYP1A2 metabolic pathway in the former. The fact that these were young children with minimal lung and liver disease suggests that enhanced drug metabolism in children with cystic fibrosis is hereditary rather than secondary to lung and liver damage.

Breath Tests↗
PubMed1996

The management of febrile seizures in the Mersey Region.

The management of children with febrile seizures admitted to hospital within the Mersey region was evaluated by case note review. The patient groups were demographically similar in all the participating hospitals. Most children were admitted for less than 48 hours and nearly all received paracetamol as an antipyretic. There was a marked variation in the number of investigations performed in each hospital, with venepunctures for blood cultures and white blood cell counts ranging from 6 to 56% and from 8 to 70%, respectively. The majority of children had a urinalysis. 23 to 78% of children were prescribed antibiotics. Further studies are required on the value of hospital admission and the appropriate use of investigations and antibiotics in children with febrile seizures.

Acetaminophen↗
PubMed1996

Steady-state plasma concentrations of midazolam in critically ill infants and children.

OBJECTIVE: To determine the steady-state plasma concentrations of midazolam in critically ill infants and children. DESIGN: Prospective uncontrolled study conducted over 18 months. SETTING: Regional pediatric intensive care unit in a children's hospital. PATIENTS: Thirty-eight infants and children, aged 1 month to 13 years, requiring midazolam as sedation during mechanical ventilation. The patients were divided into three age groups: (1) infants less than 12 months (n = 16); (2) children 1-2 years (n = 12); and (3) children aged 3 years and older (n = 10). MAIN OUTCOME MEASURES: A single blood sample was collected once steady-state plasma concentrations of midazolam were achieved during a continuous intravenous infusion. Plasma clearance was calculated from the plasma concentrations and infusion rate. RESULTS: The plasma clearance was higher in children aged 3 years and older (median plasma clearance 13.0 mL/min/kg) than in infants and children 1-2 years old (median plasma clearance 3.1 and 2.3 mL/min/kg, respectively) (Kruskal-Wallis analysis of variance, p < 0.01). The midazolam infusion rates were similar for the three groups studied (Kruskal-Wallis analysis of variance, p > 0.05). The plasma concentrations of midazolam were significantly lower in children 3 years and older (median plasma concentration 128 ng/mL) than in infants and children 1-2 years old (median plasma concentrations 395 and 790 ng/mL, respectively) (Kruskal-Wallis analysis of variance, p < 0.05). CONCLUSIONS: The plasma clearance in children 3 years and older was higher than in infants and children up to 2 years old. There was considerable interindividual variation in the steady-state plasma concentrations of midazolam in critically ill infants and children.

Adolescent↗
PubMed1995

Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus.

Lorazepam was compared with diazepam for the treatment of acute convulsions and status epilepticus in 102 children in a prospective, open, 'odd and even dates' trial. Convulsions were controlled in 76 per cent of patients treated with a single dose of lorazepam and 51 per cent of patients treated with a single dose of diazepam. Significantly fewer patients treated with lorazepam required additional anticonvulsants to terminate the seizure. Respiratory depression occurred in 3 per cent of lorazepam-treated patients and 15 per cent of diazepam-treated patients. No patient who received lorazepam required admission to the intensive care unit for either respiratory depression or persisting status epilepticus. Rectally administered lorazepam appeared to be particularly valuable (100 per cent efficacy) when venous access was not possible.

Administration, Rectal↗
PubMed1995

Adverse drug reactions in a paediatric intensive care unit.

Adverse drug reactions (ADRs) were prospectively studied in critically ill infants and children. Seventy-six ADRs were reported in 63 patients out of a study group of 899 patients. The majority of the ADRs were mild (49), although 19 were of moderate severity and 8 were severe. Thirty-five ADRs required treatment or alteration in treatment. Midazolam, morphine, salbutamol, vecuronium, hydrocortisone and theophylline were the drugs most likely to cause an ADR. One-third of the ADRs were due to drugs used outside their product licence. The majority of the ADRs were reported by nurses (36) and pharmacists (30). We believe that it is possible to prospectively study drug toxicity in critically ill infants and children.

Adolescent↗
PubMed1994

Inhibition of caffeine metabolism by ciprofloxacin in children with cystic fibrosis as measured by the caffeine breath test.

The caffeine breath test was carried out in six children with cystic fibrosis, before and during a course of ciprofloxacin. There was a significant decrease in the 2 h cumulative labelled CO2 exhaled during ciprofloxacin treatment, mean difference (s.d.) -5.2(3.3)%, P < 0.02. The results suggest an inhibition of 3-N-demethylation of caffeine (CYP1A2 enzyme activity) by ciprofloxacin. Ciprofloxacin may cause significant drug interactions in children with cystic fibrosis. The caffeine breath test can be used to study drug interactions involving CYP1A2 in children.

Adolescent↗