Revital Greenberg

Use of antibiotic and analgesic drugs during lactation.

During lactation, multiple situations can arise that require maternal pharmacological treatment. Because of the many health advantages of human milk to infants, breast feeding should be interrupted only when the needed drug might be harmful to the nursing child and exposure via the breast milk will be sufficient to pose a risk. Since the majority of drugs have not been shown to cause adverse effects when used during lactation, and even temporary interruption of breast feeding can be difficult for the nursing dyad, decisions regarding maternal medication use during breast feeding should be based on accurate and up-to-date information. This article reviews available data on the most commonly used antibiotics and analgesics.The use of most antibiotics is considered compatible with breast feeding. Penicillins, aminopenicillins, clavulanic acid, cephalosporins, macrolides and metronidazole at dosages at the low end of the recommended dosage range are considered appropriate for use for lactating women. Fluoroquinolones should not be administered as first-line treatment, but if they are indicated, breast feeding should not be interrupted because the risk of adverse effects is low and the risks are justified.Paracetamol (acetaminophen), low-dose aspirin (acetylsalicylic acid) [up to 100 mg/day] and short-term treatment with NSAIDs, codeine, morphine and propoxyphene are considered compatible with breast feeding.Safer alternatives should be considered instead of dipyrone, aspirin at a dosage >100 mg/day and pethidine (meperidine).In the light of the many safe alternatives for pain control, breast-feeding mothers should not be allowed to experience pain or be made to feel that they must choose between analgesia and breast feeding.

Colonization rate of bacteria in the throat of healthy infants

OBJECTIVE the human throat is a major ecological site for various bacteria that can reach neighbouring sterile sites and cause mild infections or invasive diseases. The aim of this study was to investigate the carriage rate of several potential pathogens in the throat of healthy children under the age of 2 years. METHODS cultures were taken from the tonsils of 1000 healthy infants aged 1-24 months attending well-baby clinics, who had not received antibiotic therapy during the preceding 14 days. RESULTS one hundred and ninety-eight (19.8%) cultures were positive. Thirteen (1.3%) cultures were positive for beta-haemolytic Streptococcus group A, 23 (2.3%) for Streptococcus pneumoniae. In 28 (2.8%) and 24 (2.4%) cultures, respectively, Haemophilus influenzae Type b and non-typeable Haemophilus influenzae were recovered. The commonest bacterium found was Staphylococcus aureus (99 positive cultures). Eleven children carried two species of bacteria and from one 6-month-old child three species were isolated concurrently. CONCLUSIONS it is concluded that children younger than 2 years of age can be carriers of several types of pathogenic bacteria. In contrast to many other studies, in this study beta-haemolytic Streptococcus group A was isolated from the tonsils of children younger than 1 year of age.

Repeated supratherapeutic doses of paracetamol in children- : a literature review and suggested clinical approach

The safety of paracetamol when given in the recommended dosage is well documented. However, in recent years there have been many reports of liver failure associated with repeated exposure to supratherapeutic doses of paracetamol. This paper reviews the literature on chronic supratherapeutic paracetamol exposure in children and the different dosing guidelines. Based on which, we suggest the following approach: liver injury secondary to repeated dosing of paracetamol should be considered when a child has received more than 75 mg/kg/d for at least 2 d, or if risk factors for paracetamol toxicity have been identified. Liver transaminases, coagulation factors, and paracetamol serum concentrations should be measured in these children and in symptomatic children with vomiting, right upper quadrant abdominal pain, and jaundice who have taken paracetamol. Treatment with N‐acetyl cysteine should be started regardless of paracetamol concentrations if transaminases or INR are elevated.

Awareness of folic acid for neural tube defect prevention among Israeli women

The failure of neural tube closure during early embryogenesis results in a range of neural tube defects (NTD), the most common of which is spina bifida. The role of folic acid in reducing the rate of NTD has been well-established. Three recent cases of infants with NTD inspired this investigative study into the level of awareness and knowledge of folic acid and its function in the prevention of NTD among Israeli women. Of 920 women interviewed, only 51 (5.5%) had heard of folic acid, and 27 (2.8%) were reported to have taken it. The source of information and the motivation for self-medication were also explored with regard to socioeconomic and health profile. Awareness of folic acid was significant among women aged 17-29 years (P = 0.005) and those aged 30-39 years (P = 0.009), and among semireligious and nonreligious women (P = 0.008 and 0.01, respectively). Among women who were aware of folic acid, only nonreligious women tended to take it. No correlation was found between folic acid intake and age, religiosity, nationality, number of pregnancies, and health status among women who were aware of folic acid intake. The poor level of awareness, evident in our study, demands that the medical community broadcast the benefit of folic acid. Furthermore, government health initiatives, such as the addition of folic acid to flour preparations, may effectively ensure its appropriate daily intake. These improved education and prevention programs may forcibly reduce the rate of NTD-affected pregnancies.

Therapeutic drug monitoring of once daily gentamicin in serum and saliva of children.

Abstract Gentamicin is widely used in paediatric medicine and therapeutic monitoring is mandatory due to the narrow margin of safety. Saliva sampling may be of potential interest, especially in children in whom blood sampling is often difficult. Experience with once daily intravenous administration of aminoglycosides has grown in recent years. Gentamicin levels were measured in serum and saliva of 55 children treated with the drug (5 mg/kg per day), administered intravenously in three different regimens: thrice (n=19), twice (n=18), and once daily (n=18). No correlation was found between serum gentamicin concentrations and saliva levels when the drug was administered twice or thrice daily, however, there was good correlation when the drug was administered once daily (r2=0.96, P < 0.0001). Conclusion In children with uncomplicated infections treated with once daily gentamicin, trough concentrations of the drug can be monitored in saliva.

Efficacy of orally administered deferoxamine, activated charcoal, and sodium bicarbonate in acute iron intoxication in rats: implications for the treatment of pediatric iron poisoning

Abstract Background: Iron supplements are the most frequent cause of pediatric fatalities from unintentional ingestion. The ability to prevent iron absorption from the digestive tract is limited. Although activated charcoal (AC) alone does not absorb iron, the oral administration of deferoxamine (DFO) and AC has been shown to reduce iron absorption in human volunteers. In the presence of sodium bicarbonate (NaHCO 3 ), ferrous iron is oxidized to ferric iron. Therefore, the coadministration of DFO, AC, and NaHCO 3 may enhance enteral iron chelation. Objective: The purpose of the study was to determine whether the oral administration of DFO and AC, with or without NaHCO 3 , can reduce iron absorption from the digestive tract. Methods: In a rat model of acute iron overloading, ferrous sulfate (FeSO 4 ) 100 mg/kg body weight was administered by gavage, followed by DFO 150 mg/kg, AC 500 mg/kg, and NaHCO 3 1 mEq/kg. Results: The administration of FeSO 4 100 mg/kg increased serum iron concentrations to > 350 μg/100 mL. Oral dosing with DFO and AC (separately and simultaneously, immediately or after 10 to 20 minutes) did not prevent iron absorption from the digestive tract. Subsequently, however, DFO significantly decreased the elevated serum iron concentrations ( P 3 further decreased ( P Conclusions: Although orally administered DFO and AC do not prevent iron absorption from the digestive tract, DFO does increase the rate of iron excretion from the body, and NaHCO 3 enhances this effect.

Metoclopramide for nausea and vomiting of pregnancy: A Prospective Multicenter International Study

Metoclopramide is a dopamine receptor blocker that depresses the vomiting center in the brain. It readily crosses the term placenta, but whether appreciable placental transfer occurs in the first trimester is unclear. Because metoclopramide is used to treat nausea and vomiting in pregnancy, this prospective study examined the effects, if any, of intrauterine exposure to the drug in 175 women given metoclopramide who consulted six teratogen information centers in Israel, Italy, Brazil, and Canada. The control group included the same number of pregnant women consulting the same centers who used drugs known not to be embryotoxic or teratogenic. The groups were matched for age, smoking status, and alcohol consumption. Women were called 4 to 15 months after delivery. The daily dose of metoclopramide averaged 23 mg, and the mean duration of treatment was 10 days. Premature births were significantly more frequent in women taking metoclopramide (8.1% vs. 2.4%), but no increase in major malformations was noted after first-trimester exposure to the drug. When gross motor developmental milestones were monitored using the Denver Developmental Scale, no difference was found between infants of women taking metoclopramide and those of women taking other drugs. These findings suggest that women taking metoclopramide to combat nausea and vomiting in the first trimester of pregnancy probably are not at increased risk of spontaneous abortion or infant malformations.