Pharmacotherapy in a Multidisciplinary Paediatric Hospital: Polypharmacy and Drug–Drug Interaction Risk Illustrated with a Clinical Case

Nowadays, the problems caused by polypharmacy are recognised and widely discussed in the medical community. Multimorbidity, which is not uncommon in paediatric practice, comes with an increase in the number of prescriptions and necessitates an active search for tools to reduce the potential risk and frequency of adverse drug–drug interactions in paediatric patients.The aim of the study was to use a clinical case to illustrate the need for monitoring, including laboratory monitoring of pharmacokinetic parameters, during concomitant therapy in paediatric practice.Materials and methods: the study consisted in a retrospective analysis of the archived medical records of an 11-year-old child with nephrotic syndrome associated with a concomitant tuberculous process who had been receiving inpatient treatment with immunosuppressants at the Russian Children’s Clinical Hospital from May to July 2018.Results: the prescription of cyclosporine for nephrotic syndrome entailed monitoring of plasma drug levels for potential pharmacokinetic interactions with the medicinal products used to treat the concomitant disease. The monitoring revealed an interaction between cyclosporine and rifampicin at the level of biotransformation. An adjustment of the concomitant therapy (discontinuation of rifampicin) allowed for achieving the target blood cyclosporine concentration, decreasing proteinuria and hypercholesterolemia, and increasing the blood total protein level in the child, which indicated the effectiveness of the ongoing treatment for the chief complaint.Conclusions: the data obtained suggest that laboratory monitoring of pharmacokinetic parameters in paediatric polypharmacy can increase the effectiveness of therapy and prevent adverse reactions and irrational combination of medicinal products

Neurotoxicity of drugs

Neurotoxicity is not uncommon in use of the drugs in many therapeutic classes. Manifestations of neurotoxicity vary from ototoxicity, visceral neuropathy and neuromuscular blockade (defeat of the peripheral nervous system) to impaired consciousness, nonspecific encephalopathy, seizures and non-convulsive epileptic status (central nervous system damage). The article presents predisposing factors of neurotoxicity, as well as the mechanisms of its development. On the example of neuroactive drugs (anticonvulsants, anesthetics and psychotropic drugs) their effect in the antenatal period and during lactation is examined. In the post-neonatal period antibiotics play an important role in the neurotoxic effect, in particular, ß-lactams and fluoroquinolones

The era of Belousov Yuri: continuing the tradition. To the 80th birthday

The article is dedicated to the outstanding scientist, doctor, teacher, public figure, corresponding member of the Russian Academy of Sciences, professor, doctor of medical sciences Belousov Yuri, who would have turned 80 on September 23, 2022. The presented materials make it possible to recall the main milestones in the biography of this remarkable person. The article is based on materials collected by relatives, friends, colleagues and students of Yuri Belousov

Drug induced haematotoxicity

The main types of hematological complications related to ongoing pharmacotherapy - (different types of cytopenia, as well as coagulopathy) are presented. The risk factors and mechanisms of development of these disorders are discussed. The authors emphasize the importance of awareness by doctors of the existence of drug induced pathology (disease) as a separate type of iatrogeny

The Case of Сushing Syndrome in a Child of 15 Years after Prolonged Endonasal Use of Dexamethasone

Abstract. The article describes the case of drug Cushing syndrome as a result of prolonged (for 10 months) endonasal use of dexamethasone and oxymetazoline mixture, which was prepared by the patient’s mother. Medical control was absent. The content of dexamethasone in the vial and the concentration of oxymetazoline was not known. During the examination, in addition to Cushing syndrome, an atrophy of the nasal mucosa as a second side effect was revealed. Thus, in the above case, there were two complications of incorrect using of drugs — local and systemic

REYE-LIKE SYNDROME IN THREE-YEAR-OLD CHILD

The article reviews the literature on classical and atypical Reye’s syndrome, explores the circumstances that contribute to its  occurrence, provides criteria for diagnosing with an illustration in the form of an authentic case of Reye-like disease in a child of 3 years  old. Reye’s syndrome is a disease manifested by acute  encephalopathy in combination with fatty degeneration of the  internal organs, mainly the liver. This condition was first described in  1963 by an Australian pathologist who identified 21 cases of the  disease in children with influenza A who were taking acetylsalicylic  acid, 17 children died. In the future, the circle of infections that  preceded the development of Reye’s syndrome-acute respiratory  infections, chickenpox, entero- and rotavirus infections, in rare  cases, hepatitis A and HIV, bacterial infections: mycoplasma,  chlamydia, whooping cough, shigella, salmonella. Drugs that can cause the development of this syndrome: tetracycline,  zidovudine, diclofenac sodium, mefenamic acid, paracetamol,  amiodarone, warfarin, phenothiazine derivatives, histaminolytics  (dimedrol), valproic acid. Along with drugs, insecticides, herbicides,  hepatotoxic fungi can be used as triggers of the syndrome. There is  an age dependence of the development of this syndrome. The  pathogenesis of classic Reye’s syndrome is associated with  generalized damage to the mitochondria primarily in the brain, as well as in the liver, kidneys, muscles, myocardium and pancreas,  with the disturbance of oxidation of fatty acids in them and the  formation of fat degeneration of varying degrees. In addition to the  classic Reye’s syndrome, atypical Reye’s syndrome or Reye-like  disease is isolated, occurs in children under 5 with congenital  disturbance of oxidation of fatty acids. We observed in our clinic the  case of Reye-like disease in a girl of three years with infection and  taking antipyretics. In the discussion section, the features of the  given case are noted, the question of the appropriateness (in view of the generality of the clinic and the mechanisms of development) of  dividing the syndrome into classical and atypical is discussed. A new  name for both conditions is proposed — Reye’s disease in honor of  the discoverer, highlighting its two forms with an early and late  onset. Given the morphological changes in this syndrome —  steatosis of internal organs — authors seem to be appropriate  measures aimed at treating secondary mitochondrial insufficiency  and fatty dystrophy

A Case of Multiple Antibiotic-Associated Hepatotoxicity in an Infant

Drug induced liver injury is one of the most frequent reasons for stopping treatment and the main cause of the onset and progression of acute liver failure, requiring liver transplantation. In children antibacterial drugs are on the first place in terms of hepatotoxicity, and the hepatocellular type is the most common type of liver damage. Often there is crosssensitivity within the same group of antibiotics, for example, beta-lactams. The aim: to analyze the causes of drug hepatotoxicity in the infant child while taking antibacterial agents. The article presents a clinical case of multiple hepatotoxicity caused by antibacterial agents such as beta-lactams, fluoroquinolones, sulfanilamides in one infant child, which suggests its genetic basis. It was shown that during therapy it is important to take into account the risk factors for hepatotoxicity (age, concomitant pathology, potential drug interactions with simultaneous use) and regularly evaluate the patient’s condition taking into account possible liver damage (including laboratory tests)