Johan De Porre

Prevention of wrong route errors in a pediatric hemato-oncology ward

Three consecutive wrong route administration errors are described in detail and the ease by which enteral preparations can be given by the wrong route is discussed. By introducing the use of purple oral liquid dispensers in our pediatric department, we hope to prevent and reduce the risk of similar medications errors in the future and to improve patients safety.

What’s in a drop? Optimizing strategies for administration of drugs in pediatrics

Accurate administration of drugs is an essential part of pharmacotherapy in children. Small differences in the amount of drugs administered, might evoke different clinical effects. This is especially of concern in drugs with a narrow therapeutic index. Guided by a case that was observed in pediatrics, some practical recommendations for the administration of oral drops in children are described.

Etoposide in continuous infusion: practical recommendations for pediatric protocols.

Etoposide is a semi-synthetic podophyllotoxin used in the treatment of a wide array of solid tumors and hematological malignancies, for example, acute myeloid leukemia. Due to its poor solubility, it requires a complex formulation (including polysorbate 80, polyethyleneglycol 300, ethanol, benzyl alcohol, and anhydrous citric acid) and the need of dilution before administration. Normal final concentration ranges are between 0.2 and 0.4mg/mL. Because of the low aqueous solubility of etoposide, precipitation occurs irregularly and unpredictably. Precipitation depends on concentration, time after dilution, presence of crystallization nuclei, agitation, contact with incompatible surfaces, and other factors. Literature data suggest that the use of nonperistaltic pumps should be preferred as it reduces the incidence of precipitation within the tubing during intravenous administration (IV). Crystallization is likely to occur with concentrations greater than 0.4mg/mL. Solutions diluted to 0.2mg/mL etoposide are stable for 96 h, while 0.4mg/mL etoposide solutions are stable for 24 h, both at room temperature. It must be mentioned that stability data in literature are conflicting, highlighting again the importance of adequate stability data. Most infusions are administrated slowly over 30–60min or longer to avoid hypotension or bronchospasm. However, in some protocols, etoposide is administered in continuous infusion over 24 h during several days, which enhances the possibility of precipitation. In our hospital, we observed two cases of precipitation of etoposide during a 7-month period, both in pediatric patients treated for acute myeloid leukemia according to the DB-AML-01 protocol. The precipitation occurred during the AIET induction course (Figure 1) when Eposin (Teva Pharma) 100mg/m was administered continuously for 4 days in a concentration of 0.4mg/mL. As a result of these two cases, a series of strict recommendations were established and implemented. The recommendations were as follows: a final concentration of 0.2–0.3mg/mL – by using a higher diluting volume should be aimed, allowing a longer stability (i.e., more than the critical 24 h with a stability of 0.4mg/mL). In case of fluid restriction in the patient,