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What drugs have lead to pediatric catastrophes?
- Ceftriaxone-- biliary sludge
- Chloramphenicol- gray baby syndrome
- Benzyl alcohol- gasping baby syndrome
Is the pH of the GI tract more acidic or alkaline until the 2nd year of life?
How does the pediatric GI tract differ from adults and cause changes in drug absorption?
- Slower gastric emptying--decreased absorption due to increased degradation
- Reduced gastric motility-- longer time to C max (1st 6 months)
- Lack of intestinal flora-- decreased bioavailability of digoxin
- Approaches adult values at 6-12 months
How does IM absorption differ in neonates?
- Reduced skeletal-muscle blood flow
- Inefficient muscular contractions
- Vitamin K--beneficial because they are not making clotting factors yet
- Will take longer for the drug to go through the body and will not be absorbed as rapidly
How does IM absorption differ in infants?
Decreased due to higher density of skeletal-muscle capillaries
In what population in IM drug absorption erratic due to low amounts of muscle or muscle perfusion?
In what situations is rectal drug use preferred?
- Vomiting (APAP)
- Febrile seizure (APAP and diazepam)
Do children have a thinner or thicker stratum corneum? How does this affect absorption?
- Absorbs 3 x more than adults due to greater extent of cutaneous perfusion and hydration of the epidermis
Do children have increased or decreased ablumin and total serum protein?
What is only present for the 1st 3 months of life and has a higher affinity to bilirubin?
Why is there less free protein?
Higher concentration of bilirubin and free fatty acids
- CrCl= [length (cm) x k] /SCr
- Used in patients less than 18 y/o
What is the dose of gentamicin/tobramycin for synergy?
1 mg/kg/dose q 8h
What is the dose of gentamicin in a seious or life threatening infection? Who does this exclude?
- 2.5 mg/kg/dose q 8h
Gentamicin Peak and Trough for penumonia
- 8-10 mcg/mL
- < 2 mcg/mL ( neonates < 1 mcg/mL)
Gentamicin peak for serious gram negative infections
Gentamicin Peak and Trough for UTI and synergy
What is the standard starting dose of vancomycin
- 15 mg/kg q 6h
- 20 mg/kg q 8h
What is the goal of vancomycin?
Do you typically measure peak concentrations in vancomycin dosing?
What is the goal trough range for vancomycin?
- 10-20 mcg/mL
- Obtained 30 minutes before the next dose
- Measured before the 4th or 5th dose
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