Edward A. Bell, PharmD, BCPS

Numerous topical antiinfective products are available to your patients over-the-counter (OTC) or by prescription. Not only can the active antiinfective agents differ among these products, but their pharmaceutical dosage form (ie, ointment or cream) may as well. The indications for topical antiinfectives, including acne vulgaris, various fungal skin infections, or viral skin infections (eg, herpes simplex virus) are too broad to discuss in this column. Discussed in this month’s column will be the treatment of common bacterial skin infections, including impetigo, with topical antiinfectives.

Codeine is an opioid alkaloid naturally found in opium poppy resin, along with morphine and more than 20 distinct alkaloid chemicals. The opium poppy has been known for more than 2,000 years to have beneficial effects upon the human body, and its use is referenced in ancient writings dating back several thousand years. Codeine has been used medicinally for more than a century. Pediatric health care practitioners trained years ago likely were taught to prescribe codeine, especially acetaminophen plus codeine products, for many uses, namely for cough or mild-to-moderate pain. Post-tonsillectomy pain was a common indication for prescribing acetaminophen plus codeine. It is best, however, that these prescribing habits “die easy,” and not “die hard.”

In recent years, we have made significant strides in our understanding of the pathogenesis of asthma. As a result, specific new pharmacotherapies and therapeutic treatment strategies are now available.

Lyme disease was first described in the United States in 1975, after two concerned mothers in Old Lyme, Connecticut, reached out to rheumatologists at Yale University regarding an influx of pediatric arthritis in their community. A surveillance study in 1976 led to the realization of a connection between the deer tick population, east of the Connecticut River, and the development of the telltale erythema migrans rash. In 1978, the vector tick carrier was confirmed, and thus, the mystery of the development of Lyme disease was uncovered. However, Lyme disease continues to pose a conundrum to providers, patients and researchers. As the most widely reported vector-borne illness in the U.S., Lyme disease presents an opportunity for education and improvement in prompt diagnosis and treatment.

The last Pharmacology Consult column, “Antihistamines for the common cold: Where’s the evidence?” (September 2019), reviewed recently published data suggesting that antihistamine product use may be increasing for the treatment of common cold symptoms. Because recent recommendations and regulations have decreased the use of cough/cold products in the pediatric population, pediatric health care providers may be turning to antihistamine-based products instead. Commonly used first-generation antihistamines have strong anticholinergic properties, and recently published data from the adult population have suggested that long-term use of these drugs may increase the risk for developing dementia. As summaries of these publications find their way to the lay media, it is understandable that parents may wonder about the long-term safety of using antihistamines in children. Although the diagnosis of dementia is certainly not associated with the pediatric population, parents may still express concern about the adverse effects and long-term safetyof antihistamines.

Recommendations for the treatment of common viral upper respiratory tract infections (URTIs) in children have undergone significant changes over the past 10 years. In 2008, the FDA and the AAP recommended avoiding over-the-counter products for the treatment of URTI symptoms, including cough/cold (C/C), in young children. These products should be avoided in children aged younger than 4 years, and the AAP cautions about their use in children aged 4 to 6 years and only when the child is receiving care from a provider.

Staphylococcus aureus nasal carriage is a proven risk factor for the development of staphylococcal surgical site infections, or SSIs. S. aureus infections are associated with increased length of hospital stays, increased mortality and higher costs of medical care. Nasal colonization rates with S. aureus have been reported to reach up to 30%, with 1% to 3% having methicillin-resistant organisms.

The treatment of serious medical diseases affecting the pediatric population has seen significant advancements in recent years, with several gene therapies newly labeled for use in infants and children. Although these therapies offer tremendous hope to patients, their families and health care professionals, their availability brings many unanswered questions, including long-term clinical efficacy and concerns over reimbursement.

As readers of Infectious Diseases in Children are well aware, it is not uncommon to hear “penicillin” when parents are asked, “Does your child have any drug allergies?” However, many published studies of adults and children have demonstrated that the vast majority of patients who answer with “penicillin” — greater than 95% — are not “allergic” with respect to a demonstrable immunoglobulin E-mediated (eg, anaphylaxis) or T-lymphocyte reaction (eg, Stevens-Johnson syndrome). Most of these reported allergies are not likely to be clinically significant with repeated penicillin or beta-lactam antibiotic administration, or the reported adverse reactions were initially unrelated to penicillin administration (eg, a viral exanthem).

Community-acquired pneumonia (CAP), otitis media (OM) and acute bacterial rhinosinusitis (ABRS) are common childhood illnesses. Although OM is more typically a childhood infection, CAP and ABRS are also common in adults. However, important differences exist in pathogenesis and treatment. Causative pathogens differ between children and adults. Streptococcus pneumoniae remains the predominant pathogen, and Haemophilus influenzae causes CAP less frequently in children than in adults, although this continues to evolve with the introduction of pneumococcal vaccines and may yield future changes to recommended empiric therapy. Additionally, Mycoplasma pneumoniae is the primary atypical pathogen in pediatric CAP but usually only in certain age groups with specific presenting features, and therefore it does not warrant universal empiric coverage.