Negar Ashouri

Risk factors for nonresponse to therapy in Kawasaki disease.

OBJECTIVE To study the refractory cases of Kawasaki disease (KD) and identify potential risk factors in patients in whom standard therapy fails. STUDY DESIGN A retrospective chart review of patients with KD admitted from January 1, 2002, through December 31, 2006. Demographic, clinical, laboratory, echocardiographic, and therapeutic data were recorded. RESULTS Of 196 patients, 40 (20%) needed re-treatment. The number of refractory cases were 7 (14.3%), 6 (17.1%), 11(28.9%), 10 (24.4%), and 6 (17.6%) for 2002 to 2006, respectively. There were no significant differences in age, sex, ethnicity, number of days with symptoms at diagnosis, white blood cell count, erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). Refractory patients had higher band counts (22.7% vs 7%), lower albumin levels (3 vs 3.4), and a higher number of abnormal echocardiography results at diagnosis (80% vs 16.1%). CONCLUSIONS An elevated band count, low albumin level, and an abnormal initial echocardiography result can be useful tools to identify patients at risk for a more complicated clinical course.

Oseltamivir Pharmacokinetics, Dosing, and Resistance Among Children Aged <2 Years With Influenza

BACKGROUND Children <2 years of age are at high risk of influenza-related mortality and morbidity. However, the appropriate dose of oseltamivir for children <2 years of age is unknown. METHODS The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group evaluated oseltamivir in infants aged <2 years in an age-de-escalation, adaptive design with a targeted systemic exposure. RESULTS From 2006 to 2010, 87 subjects enrolled. An oseltamivir dose of 3.0 mg/kg produced drug exposures within the target range in subjects 0-8 months of age, although there was a greater degree of variability in infants <3 months of age. In subjects 9-11 months of age, a dose of 3.5 mg/kg produced drug exposures within the target range. Six of 10 subjects aged 12-23 months receiving the Food and Drug Administration-approved unit dose for this age group (ie, 30 mg) had oseltamivir carboxylate exposures below the target range. Virus from 3 subjects developed oseltamivir resistance during antiviral treatment. CONCLUSIONS The appropriate twice-daily oral oseltamivir dose for infants ≤8 months of age is 3.0 mg/kg, while the dose for infants 9-11 months old is 3.5 mg/kg.

Listeria meningitis after infliximab treatment of ulcerative colitis.

Listeria monocytogenes is a Gram-positive, rod-shaped, facultative intracellular organism. Listeriosis is a primarily foodborne, uncommon but severe infection worldwide. It occurs most frequently in neonates, elderly people, pregnant women, and immunocompromised individuals.Infliximab is a human-mur

Micafungin in pediatrics: when one size does not fit all

Micafungin is one of three FDA-approved echinocandins, a novel class of antifungal agents that target 1,3-β-D-glucan in the fungal cell wall. Its spectrum of activity and favorable safety profile have made it an attractive option in the treatment of invasive Candida and Aspergillus infections. Since its approval in 2005 in the US, a variety of studies describing micafungins use in the pediatric population have been published. As with many drugs, the pharmacokinetic profiles observed in the pediatric population differ from those seen in adult studies. A thorough understanding of the unique characteristics of this drug in the pediatric population is essential in order to optimize treatment outcomes for this diverse population of patients.

Oseltamivir pharmacokinetics, dosing, and resistance among children aged

BACKGROUND Children <2 years of age are at high risk of influenza-related mortality and morbidity. However, the appropriate dose of oseltamivir for children <2 years of age is unknown. METHODS The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group evaluated oseltamivir in infants aged <2 years in an age-de-escalation, adaptive design with a targeted systemic exposure. RESULTS From 2006 to 2010, 87 subjects enrolled. An oseltamivir dose of 3.0 mg/kg produced drug exposures within the target range in subjects 0-8 months of age, although there was a greater degree of variability in infants <3 months of age. In subjects 9-11 months of age, a dose of 3.5 mg/kg produced drug exposures within the target range. Six of 10 subjects aged 12-23 months receiving the Food and Drug Administration-approved unit dose for this age group (ie, 30 mg) had oseltamivir carboxylate exposures below the target range. Virus from 3 subjects developed oseltamivir resistance during antiviral treatment. CONCLUSIONS The appropriate twice-daily oral oseltamivir dose for infants ≤8 months of age is 3.0 mg/kg, while the dose for infants 9-11 months old is 3.5 mg/kg.

Oseltamivir Pharmacokinetics, Dosing, and Resistance in Children From Birth to Two Years of Age with Influenza

BACKGROUND Children <2 years of age are at high risk of influenza-related mortality and morbidity. However, the appropriate dose of oseltamivir for children <2 years of age is unknown. METHODS The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group evaluated oseltamivir in infants aged <2 years in an age-de-escalation, adaptive design with a targeted systemic exposure. RESULTS From 2006 to 2010, 87 subjects enrolled. An oseltamivir dose of 3.0 mg/kg produced drug exposures within the target range in subjects 0-8 months of age, although there was a greater degree of variability in infants <3 months of age. In subjects 9-11 months of age, a dose of 3.5 mg/kg produced drug exposures within the target range. Six of 10 subjects aged 12-23 months receiving the Food and Drug Administration-approved unit dose for this age group (ie, 30 mg) had oseltamivir carboxylate exposures below the target range. Virus from 3 subjects developed oseltamivir resistance during antiviral treatment. CONCLUSIONS The appropriate twice-daily oral oseltamivir dose for infants ≤8 months of age is 3.0 mg/kg, while the dose for infants 9-11 months old is 3.5 mg/kg.

Streptococcus pneumoniae bacteremia in Southern California hospitalized children after implementation of pneumococcal conjugate vaccine

The introduction of Streptococcus pneumoniae 7-valent conjugate vaccine has decreased pneumococcal infections in children. Recently a resurgence of invasive pneumococcal infections has been reported. Delineating populations at risk and microbiological changes responsible for this is important to develop new preventive strategies. We conducted a retrospective review of medical records of children hospitalized with pneumococcal bacteremia from July 1st 2005 through February 28th 2010 in a large tertiary care center in Southern California. We identified 74 subjects (mean age 5 yr; range 32 days to 21 yr and 2 mo) of which the majority (58.1%) had underlying medical conditions associated with increased risk for pneumococcal infections for whom pneumococcal polysaccharide vaccine is recommended after 2 yr of age. Seventy-seven isolates were recovered from 76 positive blood cultures; serotype was available for 57 isolates, 5 (6B, 14, 23F and two were 19F) were 7-valent conjugate vaccine isolates. Forty were included in the 23-valent polysaccharide vaccine. Nineteen (35.2%) were 19A. Pneumonia was common particularly among previously healthy children (74%). New vaccines, targeted against serotypes that have emerged following the introduction of the 7-valent conjugate vaccine and better utilization of existing vaccines in patients at risk should further decrease invasive pneumococcal disease.

Editor's choice: Oseltamivir Pharmacokinetics, Dosing, and Resistance Among Children Aged <2 Years With Influenza

BACKGROUND Children <2 years of age are at high risk of influenza-related mortality and morbidity. However, the appropriate dose of oseltamivir for children <2 years of age is unknown. METHODS The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group evaluated oseltamivir in infants aged <2 years in an age-de-escalation, adaptive design with a targeted systemic exposure. RESULTS From 2006 to 2010, 87 subjects enrolled. An oseltamivir dose of 3.0 mg/kg produced drug exposures within the target range in subjects 0-8 months of age, although there was a greater degree of variability in infants <3 months of age. In subjects 9-11 months of age, a dose of 3.5 mg/kg produced drug exposures within the target range. Six of 10 subjects aged 12-23 months receiving the Food and Drug Administration-approved unit dose for this age group (ie, 30 mg) had oseltamivir carboxylate exposures below the target range. Virus from 3 subjects developed oseltamivir resistance during antiviral treatment. CONCLUSIONS The appropriate twice-daily oral oseltamivir dose for infants ≤8 months of age is 3.0 mg/kg, while the dose for infants 9-11 months old is 3.5 mg/kg.