Jon Matthew Farber, MD

Dr Farber is a pediatrician in Woodbridge, Virginia.

A pharmacokinetic model suggests that although 4 daily doses of cephalexin are the standard of care for treating methicillin-susceptible 

 (MSSA) infections, 2- or 3-dose daily regimens (BID or TID) could achieve similar results.

To develop the model, investigators used data from a pharmacokinetic study in 12 children with bone and joint MSSA infections receiving cephalexin in 53 concentrations. Seven of these children were male, and median age and weight were 7.6 years and 25 kg, respectively. Samples to determine total cephalexin concentration in the blood were taken before the drug dose and at 1, 1.5, 2, and 6 hours after it. Investigators performed simulations to determine a BID and TID dosing regimen that would allow 90% or more of children to achieve the pharmacodynamics target for MSSA (when the free drug concentration exceeds the minimum inhibitory concentration [MIC] of the bacteria for at least 40% of the dosing interval).

For BID dosing, a dose of 45 mg/kg BID was required for an MIC of 1 or 2 mg/L and 80 mg/kg for MIC of 4 mg/L. For TID dosing, a dose of 25 mg/kg was needed for an MIC of 1 or 2 mg/L and 45 mg/kg for an MIC of 4 mg/L. For both BID and TID dosing regimens, a total daily dose of more than 1 mg/kg was required if the MIC was 4 mg/L.

The probability of reaching the pharmacodynamic target for MSSA was similar for doses of 80 mg/kg BID, 45 mg/kg TID, and the current standard of care, 25 mg/kg 4 times a day. Based on their modeling, investigators developed a table for a proposed BID and TID cephalexin dosing regimen for MSSA infections based on the child’s weight. They noted that these regimens should be prospectively evaluated to determine their efficacy for common childhood infections (

Gwee A, et al. Pediatr Infect Dis J. March 11, 2020. Epub ahead of print.

I have been treating impetigo and urine infections twice a day with cephalexin for some time now with good results. This study, which will need some clinical correlation, suggests that this dosing should work for more worrisome infections, such as cellulitis. Anything that reduces the number of doses needed daily and improves compliance is a big plus in my book.

Articles

A pharmacokinetic model suggests that although 4 daily doses of cephalexin are the standard of care for treating methicillin-susceptible Staphylococcus aureus (MSSA) infections, 2- or 3-dose daily regimens (BID or TID) could achieve similar results.

Can fewer daily doses of cephalexin treat MSSA?

Children are more likely to exhibit troublesome behaviors during meals if their caregivers’ use of mobile phones is “problematic,” according to a study of 84 caregivers and their children.

Investigators recruited parents of 3- to 8-year-olds while they were attending clinical appointments at an urban tertiary medical center. The average age of respondents was 32.6 years and of the children 5.8 years. Using an electronic tablet, participants completed a questionnaire to evaluate if their mobile phone use was what investigators termed “problematic.” The 10-item survey focused on symptoms of mobile phone addiction and categorized respondents as casual users (14.3% of participants), regular users (61.9%), at-risk users (19%), and problematic users (4.7%).

Caregivers also completed a 50-item survey to assess mealtime behavior and family mealtime habits. They rated how often their children engaged in troublesome mealtime behaviors, such as refusing to eat, throwing tantrums, complaining, arguing, seeking attention, getting up from the table, squirming, having poor table manners, or putting too much food in their mouths.

Analysis of the survey results showed that problematic mealtime behaviors were significantly correlated with problematic phone use, particularly among younger children (

Milkovich LM, et al. J Dev Behav Pediatr. March 6, 2020. Epub ahead of print.

Mealtime presents an excellent opportunity for families to connect. As pediatricians, we encourage parents to limit their child’s electronics. It turns out we should also do the same for parents. At mealtimes when my children were young, we would ask everyone in turn to relate one good thing that happened to them that day, to get conversations rolling.

Excessive parental cell phone use is tied to mealtime problems

Children who take proton pump inhibitors (PPIs) are at increased risk of having fractures compared with those who have no PPI exposure, according to a retrospective review of information in the Pediatric Hospital Information System database. Further, likely fracture location differs between those who are exposed to PPIs and those who are not.

Data was obtained from about 32,000 health care encounters with documented PPI use. Median age was 4 years, with children aged younger than 1 year accounting for almost one-third of patients and females representing almost one-half. Investigators also selected a propensity matched control group and evaluated patients from both groups for hospitalizations resulting from fracture during a 2-year period.

Of the 808 patients who experienced fractures during the study period, 437 were in the PPI group and 371 in the control group. The total number of fractures, including multiple fractures, was 581 in the PPI group compared with 453 among controls. In both groups, fractures were most often in the upper extremities, but the PPI group was more likely to have lower extremity, rib, and spinal fractures than was the control group. Investigators found no correlation between fracture risk and individual PPIs (

Proton pump inhibitors usually are not that effective for reflux. Earlier studies have shown they can increase the risk of allergies when the child is older. Now we can add fractures to the potential long-term adverse effects. Try not to treat spit-up with medicine and, if you do and the medicine is not 

 working for a given child, please discontinue it.

PPI exposure increases risk of fractures

Paternal smoking before conception or during pregnancy are both associated with increased risk of acute lymphoblastic leukemia (ALL) in offspring, and the risk is significant when daily smoking consumption is higher than a certain threshold, according to a recent meta-analysis.

Investigators based in China conducted a literature search of 4 electronic databases and retrieved more than 2000 articles from which they selected 17 studies for systematic review and meta-analysis. These studies encompassed a wide time span (1977-2011); were conducted in a variety of geographic areas; and yielded a total of 9127 childhood ALL cases. Eight of the studies reported effects of paternal smoking before conception and during pregnancy, 3 reported effects during pregnancy, and 6 reported effects for smoking before conception.

Analysis revealed a nonlinear dose-response relationship between paternal smoking both before conception and during pregnancy and the risk of ALL. Before conception, the smoking effect increased gradually along with daily smoking consumption but was not significant until it reached 16 cigarettes a day. Smoking during pregnancy showed a similar pattern, with a significant effect observed after 11 cigarettes a day (

We have advised parents for years to stop smoking for the sake of their children and, for mothers, the benefits of any future babies. Now we have medical reasons to persuade fathers to stop smoking as well.

Paternal smoking before conception or during pregnancy are both associated with increased risk of acute lymphoblastic leukemia in offspring, and the risk is significant when daily smoking consumption is higher than a certain threshold, according to a recent meta-analysis.

Author | Jon Matthew Farber, MD

Articles

Can fewer daily doses of cephalexin treat MSSA?

Excessive parental cell phone use is tied to mealtime problems

PPI exposure increases risk of fractures

Paternal smoking raises risk of acute lymphoblastic leukemia