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"There's an App for That!" A Review of Medication Reminders

Ying Tang Ng - noemail@kidsmeds.info — Thu, 22 Mar 2012 19:00:00 GMT

In a world of technology, there are now many different types of smartphone applications (apps) and computer programs to help us manage the busyness of our lives. Do you or your children ever forget to take their medications? There are many apps that can help remind us to take our medications and to help keep track of the medications you are on especially when you go to the doctor’s office. Given the techno-savvy nature of today’s children/adolescents, the use of such apps are more likely to be embraced than many of the calendar reminder systems which have been employed in the past.

How do I know which one is right one for me?

There are many medication reminder apps for both the iPhone and Android systems, many of which have different features. The majority of apps have reminder systems, which can be used to set alarms, send text messages, or e-mails. For older children and adolescents, text reminders or alarms can be used to remind them to take medications during school hours. In addition to sending reminders to take your medications, many apps will also keep track of all medications, refill schedules, doctor, and pharmacy contact information. For families with small children or with several family members taking medications, apps are available which can keep track of several family members medications simultaneously (RxmindMe©, PillBox©).

Many of these apps are free, however most are very inexpensive. Also noteworthy, the apps can also be downloaded on an iPod Touch® for children/adolescents that do not have phones or smartphones. Overall, reviewers find these apps helpful in reminding them to take their medications. The most common problem encountered with the medications apps is that they work for a couple of months then have problems with the app shutting down unexpectedly .

Diabetes is a chronic disease for which several apps have been specifically designed to keep track of blood sugars, medications, food intake, weight, physician and pharmacy contacts. In addition to the reminder systems, many of these apps provide graphs of blood sugars and food intake to see trends. Depending on the need, some apps only keep track of blood sugars while other apps (OnTrack Diabetes) will keep track of a combination of information (blood sugars, medications, food intake, height, weight, etc.). The majority of apps are unable to calculate the actual dose of insulin based on intake of food or blood sugars. There are separate apps that have this feature (ex: Insulin Calculator) however, based on reviews, accuracy of the apps are questionable.

Table 1: Medication Reminder Apps

Table 2: Apps for Diabetes

22-Mar-12 2:00 PM

Black Box Warnings - What do They Mean For My Child?

Catherine Revzon - noemail@kidsmeds.info — Wed, 10 Aug 2011 12:00:00 GMT

A summary of the drug's chemical description, how it works, how it interacts with other drugs, supplements, foods, and beverages, what condition(s) it treats, who should not use the drug, potential serious side effects, commonly occurring side effects, and the effects on children, pregnant women, and the elderly is provided by the pharmacy with your prescription. Complete details of this information, including evidence from clinical trials and other essential data that health care professionals use to determine whether the drug is being prescribed appropriately for your child are found in the prescribing information. This information is also known as product labeling, or the package insert. Biologic products are also dispensed with printed information.

Some drugs and biologic products carry a Black Box Warning, which is the strongest warning issued by the Food and Drug Administration (FDA). The text of the warning is surrounded by a black border and appears on the label of the drug, the package insert, and other literature that describes the medication. The black border is the reason for the name, Black Box Warning.

Just because a drug or biologic product has a Black Box Warning does not mean it cannot be safely used in your child

There are two main reasons for this type of advisory: the medication can cause dangerous side effects as compared to the benefit from the drug and a serious adverse reaction can be prevented or reduced in seriousness if the medication is used properly. Of note, Black Box Warnings may affect a drug that has been designed to be given by mouth and intravenously, but NOT as eye drops. An example of this is found in the antibiotic class, the fluoroquinolones. BlackBoxRx.com is a free website that provides a list of all the drugs that contain a Black Box Warning.

Selected medications with a Black Box Warning may be required by the FDA to distribute a Medication Guide with the prescription to the patient. The Guide contains information approved by the FDA to help avoid serious adverse events and to help the parent make an informed decision about a known serious side effect with the drug. The Guide also urges adherence to directions when using the medication for it to work best. Medication Guides should be provided by the pharmacy when your child's prescription is dispensed and can also be obtained online at the FDA's website.

Be sure to speak to your child's doctor or pharmacist if there is a concern about any drug that your child is taking or is about to take. Just because a drug or biologic product has a Black Box Warning does not mean it cannot be safely used in your child. This medication could be the best option based on your child's current condition and other components of his health history. What IS important is that parents understand the risks and the benefits of the medication and make an informed decision based on this knowledge. Adverse events are encouraged to be reported to the FDA via the MedWatch program.

10-Aug-11 7:00 AM

What is the Meningococcal Vaccine?

Rebecca Pettit - noemail@kidsmeds.info — Tue, 09 Aug 2011 16:00:00 GMT

What is the Meningococcal Vaccine?

The meningococcal vaccine protects against meningitis caused by a bacteria named Neisseria meningitides.

What is meningitis?

Meningitis is a disease that causes swelling of the membranes that cover the brain and spinal cord. Both bacteria and viruses can cause meningitis. Bacterial meningitis, such as meningococcal meningitis, is serious and can result in hearing loss, brain damage, or learning disabilities.

Is meningococcal meningitis contagious?

The bacteria that cause meningococcal meningitis can be spread to others through coughing and sneezing. When the infected person coughs the bacteria into the air a close person can breath in the bacteria and become infected. People in close contact with infected persons should receive antibiotics to help prevent them from becoming sick.

What are some signs and symptoms?

Meningococcal meningitis is a serious disease and should not be taken lightly. It can occur quickly, make you very sick and in some cases may even lead to death. The most common symptoms are fever, headache and neck stiffness. It may also cause sensitivity to light, a stomachache, confusion, and vomiting. Infants with meningitis may be irritable, fussy, not want to eat, vomit, or be less active. If these symptoms are experienced contact your doctor immediately.

What are options for prevention?

The meningococcal vaccine can decrease the risk of getting meningitis from the Neissera meningitides bacteria. It is recommended that everyone get this vaccine at 11-12 years of age and then receive a booster shot at age 16. It is important to receive two meningococcal vaccine shots. The two shots will provide the best protection against meningococcal meningitis. If the first shot in the two shot series is not given until age 13-15 years then the booster shot should be given at age 16 making sure there are 2 months between the two shots. College freshman living in dormitories that have not received the vaccine should receive one dose.

Children at high risk for meningococcal disease including those with immune system problems or those without a spleen should receive 2 doses of the vaccine at least 2 months apart and then receive a booster shot every 5 years there after. Children that travel to some foreign countries where the disease is common should also be vaccinated.

People of any age at high risk include patients with immune system problems including HIV, military personnel, and those living in dormitories should receive the vaccine. Your doctor or pharmacist can help determine if you are at high risk for meningococcal disease. Those people who continue to be at high risk should receive a booster shot every 5 years.

I heard the recommendations for the meningococcal vaccine have changed?

Yes, the 2011 vaccine recommendations have changed. The main change is that a booster shot is now recommended at age 16-18 years after the initial vaccine. This is necessary to protect against meningococcal meningitis.

The FDA also recently approved the use of the meningitis vaccine in children from 9 months to 23 months of age as a 2 dose series. The approval was the result of studies showing that the meningitis vaccine is safe in this younger age group.

What are some known side effects of the meningococcal vaccine?

Possible side effects of the meningococcal vaccine include:

Pain and redness at the injection site
Fever
Rarely a rash and allergic reaction
Rarely neurological disorder

What are some treatment options?

People suspected of having meningococcal meningitis are hospitalized and given antibiotics. Early treatment is important. The antibiotics will help fight the infection but may not prevent all of the damage the disease can cause. Prevention is the best option. All people in close contact with a patient with meningococcal meningitis should receive antibiotics to help prevent the spread of the disease.

Where can I find more information?

http://www.cdc.gov/meningitis
http://www.immunize.org

Additional References:

Committee on Infectious Diseases. Recommended childhood and adolescent immunization schedules united states 2011. Pediatrics 2011;127:387-388.

CDC: http://www.cdc.gov/meningitis/vaccine-info.html
CDC: http://www.cdc.gov/meningitis/about/faq.html
CDC: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-mening.pdf
Immunization Action Coalition: http://www.immunize.org/catg.d/p4210.pdf

Sanofi gets expanded meningitis vaccine approval. The Associated Press. Apr 25, 2011.

9-Aug-11 11:00 AM

Preparation and Administration of Subcutaneous Injections

Jena Koshaish - noemail@kidsmeds.info — Wed, 13 Jul 2011 16:00:00 GMT

Disclosure: This information is intended to educate parents and caregivers about the techniques of preparing and administering subcutaneous (SQ) injections to children. This information is not meant to replace specific instructions from your healthcare provider. We encourage all parents and caregivers to speak to their healthcare providers about receiving specific hands-on instruction to prepare and administer SQ injections before attempting it at home.

Introduction

There are several reasons why your child might have been prescribed an injectable medication. For instance, there is not a suitable alternative oral medication to treat their condition or the medication is only supplied as an injectable because it cannot be absorbed from the stomach through the oral route. Specific medical conditions that often require SQ medications are diabetes and clotting disorders of the blood. In diabetes, specifically Type 1 Diabetes, insulin is required to maintain normal blood sugar levels. This medication is only available in the SQ form. Although Coumadin, an oral medication, can be used to treat conditions involving clotting disorders of the blood, this medication involves frequent monitoring, special diets, and has an increased risk of bleeding. Therefore, SQ medications, such as Lovenox, Heparin, or Fragmin, can be used to treat clotting disorders, which have a lower incidence of bleeding and no diet restrictions.

Subcutaneous injections can be supplied as prefilled syringes or the pharmacy may provide you with a vial of medication and syringes with which to drawn individual doses from the vial. In the case of prefilled syringes, they can either be administered directly to your child or they may also be dispensed with separate, empty syringes to draw smaller, individual doses. We will discuss how to prepare individual doses from a vial of medication and an empty syringe.

Preparing Your Child’s Subcutaneous Medication

So you’re child was prescribed an injectable medication, what now? Don’t panic, this section is meant to give you step-by-step instructions on how to prepare you child’s medication. Please see the following section for specific instructions on how to administer the subcutaneous injection.

Preparing the medication from a vial and an empty syringe

Supplies you’ll need before you start:

Alcohol swaps
Cotton ball and/or a bandage
Disposable needles (sharps) container
1 ml syringes with needles
Vial of medication

Step 1:

Wash your hands with soap and water for 15 to 30 seconds and dry them thoroughly.

Step 2:

Take off the cap on the top of the vial, and swipe with an alcohol swab in 2 sweeping motions.

Your pharmacy may have given you two sizes of needles, one for drawing medication from the vial and another for administering the injection. The needle used to remove the medication from the vial is thicker (smaller gauge) and sturdier than the needle used to inject your child. The needle used to inject your child is thinner (larger gauge) to reduce pain upon injection, as well as, more flexible which may cause it to bend if used to draw medication from the vial. Therefore, it is important to remember to use the thicker (smaller gauge) needle to remove medication from the vial, and to use the thinner (larger gauge) needle to administer the SQ injection to your child.

Step 3:

Attach the needle to the syringe by twisting it onto the top of the syringe. DO NOT uncap the needle until you are ready to insert it into the vial.

Note: Skip this step if the syringe is supplied with a needle already attached.

Step 4:

Uncap the needle by pulling NOT twisting the cap directly away from the needle in a quick sweeping motion.

Do not let the exposed needle touch anything, as this will spread germs onto the needle, possibly infecting your child. If the needle touches a surface, other than the rubber stopper of the vial, remove the needle and replace it with a new capped needle. Place the old needle in your “sharps” container and begin again with Steps 3 and 4.

Step 5:

Fill the syringe with a small amount of air, usually about three-quarters of the actual dose of the medication (i.e. if the dose is 1 ml, fill the syringe with 0.75 ml of air). This will make it easier to remove fluid from the vial.

Step 6:

Puncture the rubber stopper of the vial with the needle bevel side up at a 45 degree angle. This technique will prevent coring, which is when the needle rips a small piece of the rubber stopper into the vial.

Once the needle is inside the vial, inject the air into the vial by pushing on the plunger of the syringe.

Step 7:

Lift the vial off the table, with the needle still inside, and place your left index finger and thumb around the vial. With your other hand around the syringe, pull back on the plunger of the syringe to fill it to the level of the dose your healthcare provider prescribed.

Note: Make sure that the tip of the needle remains in the fluid to avoid drawing up air into the syringe.

Step 8:

Once the syringe has been filled with the desired dose, pull out the syringe from the vial. If you notice air in the syringe pull back on the plunger and gently tap the side of the syringe, then push the plunger up just until you see the medication fill the inside of the needle hub. This will ensure that no air is injected when the medication is administered.

Step 9:

Carefully change the needles from the smaller gauge to the larger gauge needle. Do not uncap the needle until you are just about to administer the SQ injection. Please see the administration section for more instructions.

Administering Your Child’s Subcutaneous Medication

Your healthcare provider will instruct you on the preferred sites on your child’s body to administer the SQ injection. It may be helpful for another adult to hold your child in a comforting and reassuring position while you administer the medication.

Step 1:

Wipe the area with an alcohol swab where you plan to inject the medication. Allow the area to dry for 10 seconds.

Step 2:

Remove the cap of the needle and grasp the syringe, as if holding a pen.

Step 3:

Lightly pinch your child’s skin with your free hand, about 1 to 1 ½ inches.

Step 4:

Insert the needle of the syringe swiftly and firmly into your child’s skin. Inject the medication by pushing in the plunger of the syringe. Make sure to deliver the entire dose.

Step 5:

Pull out the syringe gently and press a cotton ball over the injection site for 3 to 5 seconds to make sure the medication is absorbed. You can also place a band aid on the injection site.

Step 6:

Throw away all the needles “sharps” into the container provided by your healthcare provider or a hard plastic container, like a milk jug. DO NOT attempt to recap any needles. If the vial of medication is for multiple use, be sure to store it according to the instructions provided by your pharmacist or healthcare provider.

Click here for the original pdf file with pictures.

13-Jul-11 11:00 AM

Low Molecular Weight Heparin Use in Children

Lisa Lubsch, PharmD Bradley McCrory, PharmD - noemail@kidsmeds.info — Sun, 10 Jul 2011 05:00:00 GMT

Low-molecular-weight heparin (LMWH) is a type of medicine known as an anticoagulant. These medicines are used to prevent and treat clot formation in blood vessels, also called thrombosis.

What are the different LMWHs used in children?

enoxaparin (Lovenox®)
dalteparin (Fragmin®)
tinzaparin (Innohep®)

How does LMWH work?

Two important components for forming a clot in the blood are factor Xa and thrombin. LMWH acts by stopping the activity of factor Xa and thrombin and increasing the activity of other proteins in the blood to prevent the formation of clots.

How much LMWH is needed?

The amount of LMWH given is based on the child’s medical problem requiring a LMWH and his weight. LMWH doses are based on different measurements.

enoxaparin (Lovenox®) is based on milligrams (mg)
dalteparin (Fragmin®) is based on units
tinzaparin (Innohep®) is based on units

Normally the dose is given one to two times a day. The dose may be adjusted based on lab tests.

How is LMWH given?

LMWH is given by a subcutaneous injection. A subcutaneous injection is similar to an insulin injection, and is administered into the tissue just below the skin. These injections can be given in the legs, arms or abdomen. Click here to learn how to administer shots in the abdomen. Sometimes a subcutaneous catheter may be used to help with ease of administering the medication. If a subcutaneous catheter is used, you should be taught how to use the subcutaneous catheter for administration of the medication.

What tests are needed when on LMWH?

A laboratory test may be done to monitor for the effects of the LMWH. An anti-factor Xa level in the blood (also called a LMWH level or heparin assay) will be checked after starting the medicine. Then depending on the child’s age and medical problem, the anti-factor Xa level may need to be rechecked as often as once to twice a month.

Special Instructions while receiving LMWH:

Tell your child's dentist, doctor, or surgeon at the beginning of each visit that your child is taking a LMWH
Do not give your child any other medication without first talking to your doctor or pharmacist (for example, avoid products containing ibuprofen or aspirin while on LMWH; avoid warfarin)
Do not use after the expiration date on the bottle or package
Keep this medication out of the reach of children
Monitor your child for excessive bleeding

What are the side-effects of LMWH?

Bruising
Bleeding
Irritation, burning, or pain at the injection site

When to call the doctor?

If any of the following are experienced, contact your physician immediately:

Unusual bruising, prolonged bleeding, or tender swellings without obvious cause
Nose bleeds
Heavy bleeding from the gums
Black, tarry, or bloody stools
Urine that is bloody, dark brown, or cloudy
Vomit that looks like coffee grounds or containing blood
Severe or persistent dizziness, tiredness, or weakness
Suffering a blow to the head, even without losing consciousness
Sever and prolonged headaches
Severe allergic reactions (rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the face)

Where can I get LMWH?

For most children, LMWH may be obtained at your local pharmacy with a prescription. For young children, giving LMWH at home may be a challenge because of the unique dose needed. The amount is smaller than the doses available from the drug company. Below are methods that can be used to help give LMWH’s safely to young children at home.

One way is to use a multiple-dose vial of the LMWH, if available. For example, enoxaparin comes as 300 mg/3 mL vial and the correct dose may be drawn up into an insulin syringe. This product is normally stable for 30 days after opening and may be ordered by your local pharmacy.

Another way is to dilute the LMWH to a desirable concentration with sterile water for injection. For example, if an enoxaparin dose of less than 10mg is needed, a dilution can be done (to make a concentration of 10 mg/ml or 20mg/mL). Then doses can be drawn up into 1ml syringes. This product is stable for a limited time and normally requires the help of a special pharmacy.

How to Administer Subcutaneous Injections

The following list of instructions will help you to properly administer shots to your child in the stomach:

Have your child lie down.
Wash your hands and the area of skin where you will give the shot.
Look at the syringe to be sure the drug is clear and colorless.
Take the cap off the needle. Do not push any air or drug out of the syringe before giving the shot.
Pinch a fold of skin between the fingers and thumb. Push the entire needle into the skin of the stomach area and then press down on the syringe plunger to inject the drug. Hold onto the skin the entire time you give the shot. Do not rub the site after you give the shot to minimize bruising.
Throw away syringe and needle in proper container (sharps container).
Use a different area of the stomach each time you give the shot.

You can also find more detailed step-by-step information on how to prepare and give subcutaneous shots in a related KidsMeds article.

10-Jul-11 0:00 AM

Community-Acquired MRSA Skin Infections

Wed, 23 Mar 2011 13:00:00 GMT

What is MRSA?

Staphylococcus aureus is a germ that is usually found on the skin and nose of healthy people and usually does not cause problems. Staphylococcus most commonly can cause skin infections if the skin is damaged or wounded and can be treated with antibiotics. However, methicillin-resistant Staphylococcus aureus (MRSA) is a type of this bacteria that is commonly seen in the community and does not respond to common antibiotics used for treatment. Staphylococcus (including MRSA) can also cause other types of infections in the lungs or blood as well.

What does MRSA skin infections look like?

Staphylococcus infections of the skin can be red and tender to the touch like a pimple. It can also be mistaken for a spider bite because it can sometimes result in a black area of skin surrounded by redness. MRSA is more likely to cause skin infections that have pus and look like boils than common staphylococcus. The doctor should evaluate any skin infection that causes a child to be tired and have fever.

How is MRSA spread?

MSRA usually is spread from person-to-person, but can also be spread by touching surfaces contaminated with MRSA (towels, razors, etc). Children can get MRSA infections by playing contact sports, sharing sports equipment or towels. It is important to avoid touching the wound of a person with MRSA to prevent further spread.

How are community-acquired MRSA skin infections treated?

Treatment for community-acquired MRSA skin infections depends on the seriousness of the infection. Options may include draining the infection and/or taking an antibiotic. If there is fluid or pus under the skin, it may need to be drained.

Do not attempt to drain the infection yourself. This could cause the infection to worsen or to spread to others. If the child shows no other symptoms of infection, this may be enough for treatment; however, your doctor may also prescribe an antibiotic.

Antibiotics

In addition to drainage, community-acquired MRSA skin infections can be treated with antibiotic medications. Your doctor will prescribe the appropriate medicine for your child based on his/her age, severity of symptoms, other underlying medical conditions, and potential for adverse drug side effects. Intravenous drug therapy may be needed for more serious infections. The following antibiotics may be used to treat community-acquired MRSA skin infections.

Trimethoprim/Sulfamethoxazole

Available as oral (by mouth) and intravenous preparations
May be taken with water or on an empty stomach
If using a suspension, shake well before using
Common side effects may include nausea or rash (If your child develops a rash with this medication, you should tell your doctor immediately)
May be used in combination with another antibiotic if the doctor thinks the infection may be from another type of bacteria.

Clindamycin

Available oral and intravenous
May be taken with or without food
Capsule should be taken with a full glass of water; suspensions should be shaken well before use
Children often complain of bad taste
Commonly associated with diarrhea as a side effect

Doxycycline

Available oral and intravenous
Not for children < 8 years of age
May be taken with food
Capsule should be taken with a full glass of water; suspensions should be shaken well before use
Avoid antacids, infant formula, milk, dairy products and iron for 1 hour before or 2 hours after your child takes doxycycline
May cause upset stomach

Vancomycin

Available intravenous only
Used for moderate-severe infections
Common side effects include rash, flushing of face or neck

Linezolid

Available oral and intravenous
Very expensive; may not be covered by some insurance plans
May be taken with or without food
Gently invert suspension bottle 3-5 times before use
May cause nausea, diarrhea, or headache

Things to remember about antibiotics:

Take all of the doses that your doctor prescribes, even if the infection improves
Never share antibiotics with others
Notify your doctor if infection does not seem to get better, or if symptoms worsen

Topical treatment

Your doctor may also prescribe topical treatment along with antibiotics because MRSA can live on the skin

Mupirocin 2% ointment

Your doctor may instruct you to apply the ointment to the wound or inside the nostrils because Staphylococcus aureus usually is found in the nostrils
It is important to wash your hands before and after applying the ointment
The ointment should not be applied to the eyes

Povidone-iodine, triclosan, or chlorhexidine gluconate body wash

Your doctor may instruct you to bathe/shower with one of these medications
Apply body wash to wet body and/or hair and rinse with water
Do not irritate the wound while bathing
The body wash should not be swallowed and if it gets in the eyes, rinse the eyes immediately with water
This body wash should only be used during the length of treatment and is not a substitute for everyday soap/body wash

How does one avoid getting or spreading MRSA infections?

Maintain good personal hygiene

Wash your hands often with soap and water or use hand sanitizers. More importantly, wash your hands after touching wounds or bandages
Do not share personal items such as towels, toothbrushes, bar soaps, razors, or sports equipment with others
Children should shower/bathe after participating in athletic activities
If MRSA skin infections are recurrent, bathing in a bleach bath (1 teaspoon of bleach per gallon of water or ¼ cup in ¼ full bathtub) twice a week may be helpful, but you should ask your doctor before beginning this regimen

Properly care for wounds

If wounds become red, swollen, warm, or painful, contact your doctor immediately
Keep wounds clean and dry and covered with a bandage if there is drainage
Change bandages often and always use new bandages. Be sure to throw away used bandages and wash your hands after handling bandages
Avoid touching other people's wounds or bandages
Always follow your doctor's instructions on how to take care of your wound

Do laundry and clean up

If your child gets an MRSA infection, it is important to clean all linens and clothes he/she uses. Wash clothes, bedding, and towels using hot water, laundry detergent, and bleach if it is possible
Disinfect your house by cleaning areas or items that are used often such as bathrooms, kitchens, telephones, TV remotes, and doorknobs. Using diluted bleach or other cleaning products is recommended

Can my child attend school with MRSA skin infection?

Infected children do not need to stay home from school if their infection was properly treated. Some schools may require children to stay home for at least 24 hours after starting antibiotics
If your child returns to school or athletic activity with a bandaged wound, advise him/her to keep it covered and avoid touching it
Children may be excluded from school or other activities if they have wound drainage that cannot be covered with a bandage

Things to remember:

Draining wounds should be kept covered
Follow your doctor's recommendations for wound care
Always wash hands and use gloves to care for your child's infection
Avoid contact activities until the wound has completely healed

Notify your doctor if infection does not seem to resolve, or if symptoms worsen.

References

Cohen PR. The skin in the gym: a comprehensive review of the cutaneous manifestations of community-acquired methicillin-resistant Staphylococcus aureus infection in athletes. Clinics in Dermatology 26:1 (2008), 16-26.

Klevens RM, Morrison MA, Nadle J, et al. Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States. JAMA 298:15 (2007 Oct); 1763-1771.

Kaplan, SL. Evaluation and management of suspected methicillin-resistant Staphylococcus aureus skin and soft tissue infections in children. In: UpTo Date, Torchio, MM (Ed), UpToDate, Waltham, MA, 2010.

Stevens, DL, Bisno, AL, Chamber, HF, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections. Clin Infect Dis 2005;41:1174-8.

"Information for schools/parents/students on community-acquired methicillin-resistant staphylococcus aureus (CA-MRSA).” American Academy of Pediatrics. Available at URL: http://www.aap.org/NEW/MRSA.HTM. Accessed March 23, 2011.

23-Mar-11 8:00 AM

Pinkeye in Children

Fri, 18 Mar 2011 08:00:00 GMT

What is conjunctivitis?

Conjunctivitis is inflammation of the tissue that covers the white part of the eye and lines the inside of the eyelid. It is the most likely diagnosis in someone with a red eye and discharge. It is often called “pinkeye”.

What are the types of conjunctivitis?

There are 3 main types of pinkeye: Bacterial, Viral, and Allergic pinkeye. WebMd has a complete slideshow of the different types of pinkeye.

Bacterial pinkeye is commonly caused by germs that are spread by coming in contact with the secretions of someone who has the infection or with contaminated objects and surfaces. It is highly contagious. The affected eye often is crusted in the morning. The discharge is thick and may be yellow, white, or green in color.

Viral pinkeye is typically caused by a virus that can also cause the common cold. Viral pinkeye is highly contagious. It is spread by direct contact with the secretions of someone who has the infection or with contaminated objects and surfaces. The eye may produce watery or thick discharge. Patients often complain of a burning, sandy, or gritty feeling in one eye. The eye may also be more sensitive to light.

Allergic pinkeye is caused by exposure to an allergy-causing substance, such as pollen or dander. Symptoms include itchy, puffy, red, watery eyes. This type of pinkeye is not contagious

What are some treatment options?

Bacterial: Your child’s doctor may prescribe ointments or eye drops , which contain antibiotics for the treatment of bacterial conjunctivitis. These medicines are commonly used for 7 days. For more information regarding the best way to place eye drops or ointment in your child’s eye, check out the following link from KidsMeds: http://www.kidsmeds.info/en/art/22/

Viral: There is no treatment for viral pinkeye. However, your child may get some relief from itchy eyes by using a topical antihistamine or decongestant, which are available over-the-counter. Warm or cool compresses may be comforting. Medicines used to treat pain, such as acetaminophen (Tylenol®) provide additional relief for symptoms. You can also clean the affected eye with warm water and cotton balls to help remove the crusts that cause the eye(s) to stick together in the morning. When using cotton balls or napkins, it is important to wipe from the inside corner of the eye to the outside. It’s also important to wash your hands and the washcloth immediately after to prevent spreading germs.

Allergic: Avoiding exposure to the allergen is the best treatment. Applying a cool compress over the eye may also help alleviate symptoms. Consult your child’s doctor before starting an antihistamine, since these are not recommended in children under the age of 2 years. Saline eye drops, such as Artificial Tears®, may also help relieve eye discomfort. If over-the-counter medications do not improve your child’s symptoms, you should call your child’s doctor.

When can my child go back to school or day care?

Your doctor will advise you when it is safe for you or your child to return to work or school. Since bacterial and viral pinkeye are highly contagious, your doctor may suggest staying home until there is no discharge from the eye(s) or until symptoms improve. This can take 3-5 days. For many children, most schools require that students should be receiving 24 hours of antibiotics before returning to school for bacterial pinkeye.

How can you avoid getting conjunctivitis?

Adults or children with bacterial or viral pinkeye should not share handkerchiefs, tissues, towels, cosmetics, silverware, or bed sheets/pillows with uninfected family or friends. In the summertime, pinkeye can be avoided by not allowing kids to swim in contaminated water or to share contaminated towels.

Hand washing is an important way to prevent the spread of infection. Hands should be wet with water and soap, then rubbed together for 15 to 30 seconds. Teach children to wash their hands before and after eating and after touching their eyes, coughing, or sneezing.

The best way to avoid allergic pink eye is to avoid exposure to the allergen, such as pollen or pet hair.

References:

Jacobs DS. Patient information: conjunctivitis (pinkeye). Available at URL: http://www.uptodate.com/online/content/topic.do?topicKey=eye_heal/2971&selectedTitle=3%7E150&source=search_result Accessed March 18, 2011.

American Academy of Ophthalmology. Viral conjunctivitis. Available at URL: http://www.aao.org/theeyeshaveit/red-eye/viral-conjunctivitis.cfm. Accessed March 18, 2011.

American Academy of Ophthalmology. Allergic conjunctivitis. Available at URL: http://www.aao.org/theeyeshaveit/red-eye/allergic-conjunctivitis.cfm. Accessed March 18, 2011.

American Academy of Ophthalmology. Bacterial conjunctivitis. Available at URL: http://www.aao.org/theeyeshaveit/red-eye/bacterial-conjunctivitis.cfm. Accessed March 17, 2011.

American Optometric Association. Conjunctivitis. Available at URL: http://www.aoa.org/conjunctivitis.xml. Accessed March 18, 2011.

Mayo Clinic. Pink eye. Available at URL: http://www.mayoclinic.com/health/pink-eye/DS00258. Accessed March 17, 2011.

18-Mar-11 3:00 AM

What Parents Should Know About Prevnar 13

Thu, 17 Mar 2011 13:00:00 GMT

What is Prevnar 13?

Prevnar 13 (Pneumococcal Conjugate Vaccine 13) is a new vaccine that has been approved by the Food and Drug Administration (FDA). The vaccine prevents infections caused by 13 of the most common types of bacteria called Streptococcus pneumoniae that can cause serious infections in children. Children 2 months to 5 years-old should get this vaccine during their well-child visits.

What is so special about S. pneumoniae?

There are over 90 types of S. pneumoniae. This bacteria can cause serious childhood infections, including blood infection (bacteremia), lung infection (pneumonia), and infections around the brain (meningitis). S. pneumoniae infections can be spread by direct contact or air particles. Young children under the age of 5 are more likely to get serious infections from this bacteria than healthy adults. Some infections can lead to deafness, brain damage, and, in rare cases, death. The Centers for Disease Control (CDC) recommends that all children between between 2 and 59 months of age receive this new vaccine, Prevnar 13, in order to protect them against this bacteria. Older children with certain underlying health conditions are also recommended to receive Prevnar 13.

Prevnar 13 vs. Prevnar 7 - what's the difference?

The number after the name Prevnar indicates the number of types of S. pneumoniae contained in the particular vaccine. Prevnar 7 was the first pneumococcal vaccine that became available in the year 2000. Children who have received the Prevnar 7 vaccine are protected against 7 types of S. pneumoniae that are included in the vaccine. In fact, the number of cases of serious infections caused by S. pneumoniae has dropped by almost 80% in children under 5. Prevnar 13 now replaces Prevnar 7. It has six additional types of S. pneumoniae than Prevnar 7. While it does not protect against all types of S. pneumoniae, Prevnar 13 will work against the 13 types contained in the vaccine.

Who should be vaccinated with Prevnar 13?

Prevnar 13 is recommended for all infants at ages 2 months, 4 months, 6 months, and between 12 and 15 months. A complete series is made up of 4 doses of Prevnar 13. If your child is over 12 months old and has not received the doses of Prevnar 13 during the recommended time frame, your child's doctor will help your child get caught up. Since children are frequently exposed to this bacteria, it is important to make sure your child is fully vaccinated. The total number of doses depends on the child's current age. The updated immunization schedule for children is available from the CDC. Table 1 explains the number of doses of Prevnar 13 children should receive if they started on Prevnar 7 and have not completed the series, yet.

When is Prevnar 13 appropriate for older children?

Is Prevnar 13 safe?

Yes, Prevnar 13 is as safe as Prevnar 7. Prevnar 7 has been given to children since it was available in 2000. The vaccine's side effects are well known. The most common side effects are mild and will go away on their own with time. They include: pain, swelling, tenderness, and/or redness where the shot was given. Decreased appetite, fever, irritability, and increased or decreased amount of sleep may be seen. Make sure you report other side effects to your child's doctor.

Where can I find more information?

For more information about the Prevnar vaccine, download the CDC's vaccine information sheet on Prevnar 13.

References:

CDC. Prevnar 13 (Pneumococcal conjugate vaccine 13) Vaccine Information Sheet (VIS). Accessed March 17, 2011.

CDC. Licensure of a 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and Recommendations for Use Among Children --- Advisory Committee on Immunization Practices (ACIP), 2010, Morbidity and Mortality Weekly Report (MMWR); 59(09): 258-261. March 12, 2010. Accessed March 17, 20011.

CDC. PCV13 (Pneumococcal Conjugate Vaccine) for parents. Accessed March 17, 2011.

17-Mar-11 8:00 AM

Respiratory Syncytial Virus - Not Always Just a Cold

Mon, 21 Feb 2011 22:00:00 GMT

What is respiratory syncytial virus (RSV)?

RSV is a virus that causes colds in people of all ages. However, RSV can cause a serious lung infection in infants and young children. Most children will get RSV by the age of three. RSV is most common during the winter months.

How can my child get RSV?

RSV, like other cold viruses, is easy to spread to other people by touching, kissing, and shaking hands. Sometimes it can be spread by close contact with a person who is sneezing or coughing or touching things that have RSV on them. The most common way to spread RSV is by hand contact. People “catch” RSV from other people who have colds caused by RSV.

Who is at risk?

Premature infants born more than 4 weeks early
Low birth weight babies
Babies with chronic lung disease
Babies with serious heart disease
Babies with severe neuromuscular disease
Infants who attend daycare
Infants exposed to smoke
Family history of asthma
Infants who live with school age siblings
Infants who cannot fight infections well

What are the Symptoms of RSV?

Runny nose
Cough
Fussiness
Your child may seem very tired, less active
Your child may not want to eat
Loud or fast breathing
Wheezing (a tight whistling or musical sound heard when your child breathes)
Your child’s chest sinks in with each breath
Low grade fever (in some children)
Difficulty breathing, gasping for breath

Why is respiratory syncytial virus (RSV) a concern?

Worsening symptoms can lead to severe lung infections, and may become life threatening.

How can I prevent my child from getting RSV?

There are two ways to help prevent your child from getting RSV:

1. Take everyday steps to prevent the spread of RSV, especially good hand washing;

Wash your hands before touching your baby
Ask other people to wash their hands before touching your baby
Wash hands with soap and water or alcohol-based rub
Keep your baby away from crowds
Keep your baby away from people with colds
Wash your baby’s toys and bedding often
Keep your baby away from cigarette smoke

2. A medication called palivizumab (Synagis®) is recommended for babies at high risk for RSV. It is usually given monthly during the RSV season (late fall through spring). It is not a vaccine, but it can help your baby’s immune system fight against the virus.

What is palivizumab (Synagis®)?

Some high-risk children under the age of 24 months may benefit from palivizumab, which is a medicine to help prevent RSV infections and is given as a shot into the baby’s thigh muscle. Each dose helps build the body’s immune system to fight viral infections caused by RSV for about one month. It is usually given in 1-5 monthly shots, depending on your child’s age during the RSV season. It is important that your child gets all the required doses.

How do I know my child has RSV?

It is sometimes hard to know whether your child has RSV because it can look like other infections. Illness in other family members or the time of the year may provide clues. Symptoms also differ with age. Babies under one have the most trouble breathing. If you notice a bluish skin color (not enough oxygen), difficulty breathing or labored breathing, coughing, fever, nasal flaring, fast breathing, shortness of breath, stuffy nose, or wheezing in a baby, contact the doctor. Your doctor may examine your child and also test your baby’s nose drainage to see if RSV is present. Older children may just look like they have a mild cold.

What do I do if my child gets RSV?

Make sure your baby gets enough fluids to drink
Keep your baby’s nose clean using a bulb syringe
If you are concerned, call your doctor

How is RSV Treated?

Most children get better without medical treatment. Some children, especially newborns, premature infants or infants with heart or lung problems can be sicker and may need to be hospitalized. In the hospital, your child will be watched closely. Because a virus causes the illness, antibiotics will not be useful. Some children may need oxygen, breathing treatments, medicine for fever, or fluids by IV.

Can my child get RSV again?

Yes, your child can get RSV again, but most likely it will be milder than the first time.

References:

Redbook Online. Respiratory syncytial virus. Accessed on 10/13/10
American Academy of Pediatrics. Diagnosis and management of bronchiolitis. Pediatrics 2006; 118(4): 1774-1793.
A.D.A.M. Respiratory syncytial virus. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002531. Accessed on 02/21/11.

21-Feb-11 4:00 PM

FAQ About the Flu and Flu Vaccine

Tara Smith - noemail@kidsmeds.info — Wed, 02 Feb 2011 12:00:00 GMT

Why is it important to get a flu vaccine every year?

The flu illness is caused by a virus. The flu vaccine contains three types of influenza viruses. It is updated every year to match the specific types of the flu virus that people are getting sick with. It is important to get the current vaccine each year to protect you and your child against the type of virus that is most likely to cause the flu illness this year.

Why do some children need 2 flu vaccines and others only need vaccine?

Children ages 6 months to 8 years will need 2 doses of the flu vaccine if they are getting the flu vaccine for the first time. The first dose will help the body’s immune system get ready to fight the flu. The second dose provides the full protection against the flu viruses. Only one dose is needed every year after. Children over the age of 8 have a stronger immune defense system and only need one dose of flu vaccine every year.

Do we need to get a separate vaccine for the H1N1 flu this year?

No. The flu vaccine for 2010-2011 protects against the seasonal and H1N1 strain of the flu virus because it is included in the vaccine.

Can the nasal spray flu vaccine cause someone to get the flu?

No. The flu vaccine in the form of a nasal spray is a weakened virus even though it is a live vaccine. The weakened virus cannot live long enough to make someone sick. The nasal spray flu vaccine will provide the same protection against the flu as the flu shot.

Is it every too early or too late to get the flu vaccine?

You should try to get the vaccine each fall as soon as it is available. The vaccine should not wear off before the end of flu season. Getting the vaccine as early as September or October is okay.

If you do not get the vaccine before the end of December, it is not too late. You should try to get it when you can. It is better to have protection against the flu, even late in the season.

Do you have a question about the flu virus or flu vaccines? Please leave a comment below or contact us via the form on the left of this web page.

2-Feb-11 6:00 AM

Summer Topics and Tips

Thu, 02 Jun 2011 21:42:08 GMT

The summer brings a variety of health challenges for people young and old as the temperatures rise and the grass grows green. From allergies to sunburns, parents and kids alike face many health-related decisions.

A few seasonal topics for Summer are listed below. The treatments described for each topic are not to be used as a substitute for recommendations made by your child's own pediatrician or pharmacist, but rather should be used to educate parents on the different categories of treatments available. The following information may not be complete and may not cover all treatments available in each category.

First Aid Fundamentals. This guide is designed to educate parents on the typical items contained in a first-aid kit and special items included when the kit is being taken to camp or sporting events.

Sunscreens: Did you ever wonder how you would possibly choose the correct sunscreen for your child when there are more than 40 different products staring you in the face? What does SPF really mean anyway, and how often should it be reapplied? We have a few answers here.

Insect Repellents: Don't get overwhelmed by the large number of insect repellent products either. Read the label and look for the main ingredient. Can't remember what the different ingredients are? Read more about insect repellents here.

Poison Ivy: What does poison ivy plants look like? How do you get the rash? How to you treat it. We have a few answers here.

Swimmer's Ear: "Swimmer's Ear" refers to an infection of the canal that connects the outside of the ear with the inside of the ear. Learn how to treat this common summer ailment here.

Winter Topics and Tips

Tue, 27 Apr 2010 21:02:52 GMT

The winter season brings cold days and beautiful snowy landscpes. The prospect of building snow men, ice skating, making snow angels, and drinking hot chocolate next to a wood burning fire place brings joy and excitement to children and families.

But winter also brings about a variety health challenges as freezing temperatures emerge.

A few winter seasonal topics are listed below. The treatments described for each topic are not to be used as a substitute for recommendations made by your child's own pediatrician or pharmacist, but rather should be used to educate parents on the different categories of treatments available. The following information may not be complete and may not cover all treatments available in each category.

Flu at a Glance: Influenza, or the flu, is a contagious infection of the respiratory tract caused by influenza viruses that can make people very sick. People with the flu might have a cough, sore throat, fever, chills, or a runny nose. They may also have a headache, muscle aches, weakness, diarrhea, loss of appetite, nausea, and vomiting.

Taming Itchy Skin in Children: The winter itch can be caused by the cold weather and dryness in the air. If left alone, the condition can worsen and lead to other skin conditions. Dry, itchy skin can be easily prevented by putting on a moisturizer every night after a bath or shower. Learn about the different products available in the pharmacy for children.

Seasonal Topics and Tips

Wed, 17 Mar 2010 18:07:07 GMT

Please click on the pictures below for information about each season.

Spring Topics

Wed, 17 Mar 2010 18:04:23 GMT

Spring is a beautiful time of year. The sun shines, the weather is warming up and the flowers are blooming. Spring also brings a variety of health challenges to people of all ages and kids are no exception.

First Aid Fundamentals. This guide is designed to educate parents on the typical items contained in a first-aid kit and special items included when the kit is being taken to camp or sporting events.

Don't Let the Ticks Bite. This article tells you everything you've ever wanted to know about ticks and tick bourne diseases. It also gives tips on how to prevent those diseases and treat them if need be.

Don't Let the Ticks Bite

Wed, 17 Mar 2010 06:01:05 GMT

I. QUICK SUMMARY OF TICKS AND TICKBORNE DISEASES What are ticks? Ticks (Ixodidae) are six-legged insects responsible for transmitting diseases caused by bacteria and parasites. Ticks have four stages in their life cycle: egg, larva, nymph, and adult. Nymphs must feed once to develop into an adult tick. When they feed on blood from an animal infected with rickettsia, they become infected. After ticks develop into adults, the infection may be spread to humans or other animals during their feeding process. Humans may be bitten by either the male ticks or female ticks, but females are responsible for spreading most of the infections. What do ticks look like and what diseases do they transmit to humans? Ticks are hard to spot at a glance. In fact, nymphs are the size of poppy seeds. The following table describes the different kinds of ticks, their reservoirs, places where they are commonly found, and infections they can cause. What ticks look like ...

Library of Links

Mon, 07 Jul 2008 22:13:47 GMT

Welcome to our Links Library. We have searched all over the web to find you the most valuable information on the Internet.

The Links Library is divided up into different sections for ease of use. We have a section just for kids, parents and pharmacists and other health care providers.

We hope you enjoy this resource.

My Medication List

Mon, 30 Jun 2008 19:45:17 GMT

Do you remember all of the medications (and what doses) you are taking?

"My Medications List" can help you keep track of all of your medications. It can also help you keep track of the vitamins and herbal supplements.

It is important to keep track of all of your medications, vitamins, and herbal supplements. In will help your doctors, nurses, pharmacists, and other health care providers take better care of you.

To the left, Dr. Katie Wassil speaks about the importance of keeping track of your medicine and communicating with your physician and pharmacist.

To print the "My Medications List" please click here or the icon below:

"My Medications List" was developed by the Advocacy Committee of the Pediatric Pharmacy Advocacy Group.

Kids and Medicine

Mon, 30 Jun 2008 19:30:27 GMT

There are over 50 million children in the United States, most of whom receive drug therapy sometime during their childhood. Whether this drug therapy is an antibiotic for infection, an antipyretic for fever, an antiseizure drug, an anticancer drug, or any other type of drug, there is a need for knowledge about how children absorb, metabolize, and eliminate these drugs to facilitate their optimal use. However, with many drugs, such detailed information in children is not available. Nearly 80% of medications marketed in the United States carry no recommendation for use in children. The development of new drugs over the past three decades has revolutionized the therapeutic arsenal available for today’s clinician. However, children have not fully benefited from these therapeutic advances. Although medications continue to be used extensively in the pediatric population, our knowledge regarding their use remains limited. Childhood is a period during which there are significant...

About Membership

Mon, 30 Jun 2008 19:23:00 GMT

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Poison Ivy and Related Plants

Fri, 27 Jun 2008 19:38:44 GMT

Contents of this page: What do the plants look like? How do the kids actually get the rash? Does it spread? What if the blisters pop? Once they have it! Preventing Poison Ivy Treatment Objectives Treatment Options: Astringents Hydrocortisone Antihistamines Local Anesthetics When to see your pediatrician What do the plants look like? There are three types of plants that can cause a skin rash to develop when your child comes in contact with them. Sometimes we tend to lump them all together and refer to them as poison ivy. The three culprits are known separately as poison ivy, poison oak, and poison sumac. Each of these contains toxicodendrol within their stems and leaves. Toxicodendrol is an oil that contains an active ingredient known as urushiol. The urushiol is the chemical that actually causes the skin to have a reaction known as contact dermatitis. A contact dermatitis can be any inflammation of the skin that...

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noemail@kidsmeds.info — Tue, 16 Oct 2007 14:11:36 GMT

Objectives:

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Release Date: 16-Oct-07 9:11 AM
Expiration Date: 16-Jan-08 9:11 AM

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2007-10-16T14:11:36Z

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