Facteurs influençant l’acceptabilité des formulations galéniques en pédiatrie – revue de la littérature

Pediatricians' awareness of galenic drugs for children with special needs: a regional survey

The prevalence of children with medical complexity is increasing, therefore drug formulations must be updated in accordance with their needs. Furthermore, a different drug formulation may be also needed for patients who require a very low dosage which is not easily reachable with those of the industrial products or for those following a ketogenic diet. Galenic (or compounded) drugs have been recently pointed out as effective in treating children. Nonetheless, their knowledge among healthcare providers is limited. We investigated how much did pediatricians know about galenic compounds by a short questionnaire administered to family and hospital pediatricians and pediatric residents in Friuli Venezia Giulia, Italy. We collected answers from 65 family pediatricians (57,5%), 39 hospital pediatricians (36,1%), and 47 pediatric residents (41,2%). Overall, both family and hospital pediatricians substantially know what is a galenic compound and the indications to its use. Of note, most of pediatricians ignore which is the legislation that allows the galenic compounds' preparation and use, and which is the correct procedure to prescribe them. Moreover, half of the hospital pediatricians and one-third of the family ones erroneously stated that galenic formulations cost more or like the industrial products, and around the 15% of both categories affirmed that galenic compounds are less safe than the commercial product. In conclusion, the use of galenic drug may significantly improve children's and caregivers' quality of life. We believe that all pediatricians should be updated on this quite new and interesting topic.

Impact of compounded drugs on the caregivers' burden of home therapy management in pediatric palliative care: A descriptive study

BACKGROUND

Children with medical complexity need complex assistance, that considerably affects caregivers' quality of life. They often need multiple medications, with a consequent relevant risk of errors or poor compliance. Galenic (or compounded) drugs are blended in the pharmacy's laboratory worldwide according to different rules and tailoring the patient's needs. While their use may sometimes simplify these therapies, little is known about parents' attitude about this issue.

AIM

This study aimed at investigating the complexity of the daily therapy management and exploring the parents' opinions about galenic compounds.

DESIGN

Parents were interviewed by using a structured questionnaire.

SETTING

Children followed by the Pediatric Palliative Care Network in Friuli Venezia Giulia, Italy, were included from November 2021 to April 2022. Those diagnosed with malignancies were excluded, since therapies are mainly administered through a central venous catheter.

RESULTS

Thirty-four parents were interviewed. Fourteen patients took drugs orally, one via nasogastric tube (NGT), 18 via gastrostomy, and one orally + NGT. The mean number of drugs taken every day was six (2-14), in mean 10 (3-18) administrations, that overall required a mean of 44 (8-180) minutes to be delivered. Twenty-eight parents used galenic compounds, and 24 reported relevant advantages, because of a ready-to-use and safe formulation.

CONCLUSIONS

The therapy management of children with medical complexity relies on parents. Galenic compounds may improve both patients' and caregivers' quality of life, either in terms of shorter time of administration or smaller risk of errors. Therefore, their use should be encouraged worldwide, according to the different reference rules.

Safety and effectiveness of compounded galenic cholic acid for bile acid synthesis disorder: a case report

BACKGROUND

Bile acid synthesis disorders are rare congenital diseases which, if untreated, can lead to cirrhosis and end-stage liver disease. Cholic acid administration is the only treatment which can prevent patients from fatal outcomes. Since 2013 in Europe there is just one formulation of cholic acid: Orphacol®. It is difficult to administer to infant patients because of its formulation (capsules) and the need for dose titration in relation to the patient's weight.

CASE PRESENTATION

Two sisters affected by 3-β-hydroxy-Δ-5-C27-steroid dehydrogenase deficiency showed soon after birth failure to thrive, cholestasis and fat-soluble vitamin deficiency. Cholestasis and an initial liver damage were confirmed by both biochemical findings and liver biopsies. Patients were treated for eight years with a liquid formulation of cholic acid galenic compound and then they started to be treated with capsules of the registered drug. Clinical conditions and biochemical findings were checked periodically during both therapies.

CONCLUSION

Clinical and laboratory data showed no differences between the cholic acid galenic compound and the registered drug in terms of both efficacy and safety. Furthermore, the galenic compound showed benefits of more manageable dose titration, easier intake due to its liquid formulation, and lower costs than commercial cholic acid capsules.

Design and validation of quality indicators for drug dispensing in a pediatric hospital

OBJECTIVES

This article presents a methodological strategy to design and validate quality indicators for drug dispensing in a pediatric hospital.

SETTING

The literature evaluation, design, and validation of indicators by experts were carried out from September 2017 to March 2018 in the pharmaceutical services of a pediatric hospital at the Autonomous University of the State of Hidalgo, Mexico.

PRACTICE DESCRIPTION

The design and validation of quality indicators for dispensing allow the evaluation, planning, and follow-up of this activity.

PRACTICE INNOVATION

The development of the indicators follows a holistic vision considering the relationship between the structure on which the pediatric dispensation is based, the involved processes, and the outcomes and provide a simple tool to improve the quality of the dispensing service.

EVALUATION

A methodological investigation for the development of systems and health services in drug dispensing was performed. For the indicator's design, the Mexican standards for establishments dedicated to the sale and supply of drugs, the Good Dispensation Practices, and the Donabedian model were considered. The validation of such indicators was carried out using the Delphi method and the Torgerson mathematical model.

RESULTS

Indicators of structure, process, and results were designed; of the 16 indicators designed, 15 reached the average score of greater than 3.5, and the percentage of experts who qualified each indicator in the highest categories was greater than 50%.

CONCLUSION

The design of indicators guarantees the quality of the dispensing service and can be extrapolated to the pharmaceutical services of any pediatric hospital.

Organoleptic excipients used in pediatric antibiotics

Taste is a crucial factor that determines the palatability of the oral dosage form and patient compliance.

OBJECTIVE

The aim of this work was to evaluate the organoleptic excipients in oral antibiotics for pediatric use marketed in Brazil.

METHODS

The information was obtained from the GuidetoPharmacy, a reference for the pharmaceutical trade. The analysis included dosage forms for oral administration and drugs and their combination with antibacterial action. After this survey, we identified the constitution of the flavoring, sweetening, and coloring agents of each medicine. The results are presented in a descriptive form.

RESULTS

Twelve drugs or associations are distributed in 70medicines. Oral suspension was the most common pharmaceutical dosage form. Sweeteners were sucrose, sodium saccharin, and sodium cyclamate. All the coloring agents observed are synthetic and the most frequent ones were yellow twilight no. 6, yellow tartrazine no. 5, and red ponceau 4R. The presence of two or more types of flavorings per medicine was observed.

CONCLUSION

Antibacterials use coloring agents, flavorings, and sweeteners to facilitate the administration of medicines for children, using up to six different substances per formulation. No natural coloring agent was observed, demonstrating an issue to be explored in the future. It is important to note that, although necessary, these excipients are responsible for a high incidence of allergic reactions in children.