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Biomedical subjects

A P Jonville

Publications and source records attributed to A P Jonville.

At least 19 recordsLinked to original sources

Comparative efficacy and tolerance of ibuprofen syrup and acetaminophen syrup in children with pyrexia associated with infectious diseases and treated with antibiotics.

A double-blind, randomised, parallel group study has been done comparing the efficacy and tolerability of 7.5 mg/kg ibuprofen syrup (n = 77) and 10 mg.kg-1 acetaminophen syrup (n = 77) in 154 children (6 months to 5 years) with fever (> or = 38 degrees C) associated with infectious diseases and treated with antibiotic therapy. The area under the percentage reduction in temperature curve captured the net effect of each drug and provided the best estimate for comparison of efficacy during a defined period. Temperature evolution over time was not significantly different between the two groups. Nevertheless, the temperature reduction over the first 4 h of treatment (H0-H4) was significantly higher after ibuprofen (60%) than acetaminophen (45%). Both ibuprofen and acetaminophen were well tolerated. In conclusion, significant antipyretic activity, good tolerability and its availability as a syrup make ibuprofen an effective means of fever control in children.

Acetaminophen↗

Plasma levels of oxybutynine chloride in children.

Anticholinergic adverse-effects in children treated with conventional doses of oxybutynine led us to measure plasma oxybutynine levels in children. 18 children, aged 5 to 13 y, who required treatment with oxybutynine chloride for daytime incontinence were studied. Plasma concentrations were measured on the fifth day of a course of treatment in which the dose was adapted to the child's body weight; the dose was given twice daily at 12-hour intervals. In 10 children aged between 5 and 8 y, the mean dose was 0.1 mg.kg-1. In 8 children aged between 10 and 13 years, the mean dose was 0.15 mg.kg-1. The highest concentration was usually found between 1 and 2 h after administration. The subsequent fall in concentration was rapid and after 6 h oxybutynine was no longer measurable in 14 of the children. The concentrations found were not different from those seen in adults given equivalent doses. The results show that plasma concentrations in children were not very different from those observed in adults if the dose were adapted to the body weight of the children. No special differences in paediatric use were revealed that might explain the particular adverse-effects. The results of the study argue against the dosage regimen proposed before these adverse events were detected. They strongly favour a dose adapted to the body weight of the child, with a 12-hour interval between doses.

Adolescent↗

Parental opinions about biomedical research in children in Tours, France.

In order to evaluate parental awareness of the law governing clinical trials in France (Loi Huriet), a study was performed by questionnaire between February and April 1991 in a maternity unit during the days following delivery. The response rate was 59%. 59% of the parents (319/541) were informed of the existence of the law by the media (75%) or their general practitioners (12%). Twenty-one percent (116/541) of the parents would accept the participation of their children in a clinical trial and 74% would refuse. The principal reasons for acceptance were: for the benefit of other children, contribution to medical progress and confidence in physicians. The reasons for refusal were: risk of side effects and unproven efficacy. Parents who would accept had more often received higher education (44%) than parents who would refuse (30%), the latter being less influenced by the explanations of physicians and less willing to accept that a physician should decide for them. Physicians should consider transmitting information directly to parents and indirectly via the media.

Adult↗

Pharmacokinetics of paracetamol in the neonate and infant after administration of propacetamol chlorhydrate.

The pharmacokinetic parameters of paracetamol were studied after 15 min intravenous infusion of 15 mg/kg of propacetamol (Prodafalgan) in 5 neonates aged less than 10 days and 7 infants aged between 1 and 12 months. Blood was sampled at 0, 0.5, 2 and 6 h after the first intravenous infusion of propacetamol. The infants aged less than 10 days had higher plasma concentrations of paracetamol, a longer half-life (3.5 vs. 2.1 h) and a lower plasma clearance (0.149 vs. 0.365 l/h/kg) than the older children. Dose simulations were performed on the basis of individual data of each child in order to obtain steady-state plasma concentrations between 4 and 18 mg/l permitting the best antipyretic effect for each child. In infants aged less than 10 days a 15 mg/kg dose of propacetamol four times a day (i.e. 30 mg/kg/day paracetamol) is sufficient, corresponding to the dosage recommended by the French pharmacopoeia. On the other hand, double the dosage, nearer to the American dosage, is necessary for children aged over 10 days.

Acetaminophen↗

[Adverse effects of oxybutynin chloride (Ditropan) in pediatrics].

BACKGROUND: The side effects of oxybutynin chloride (Ditropan) often include atropinic and allergic reactions. Their relative frequency in children merits a nationwide investigation. METHODS: All the side effects of Ditropan reported to the French Regional ADR monitoring centers and to the pharmaceutical firm Debat between January 1985 and June 1990 were analysed. Only 87 effects of the 286 side effects reported in adults and children occurred with sufficient frequency in 84 children to warrant study. RESULTS: The 84 children (38 males, 43 females, 3 of unknown sex) were 30 months to 15 years old (mean: 6.5 years); 13 of them were less than 5 years. The mean dose of Ditropan prescribed was 0.5 +/- 0.12 mg/kg/day. 52 children developed atropinic symptoms, 20 skin and/or allergic reactions and 15 various other manifestations. These side effects required admission to hospital in 14% of cases. The side effects were 4 times more frequent in children (1/4,000 regulations) than in adults. CONCLUSIONS: The higher frequency of atropinic reactions in children may be due to the higher dosage of the drug used and/or to differences in hydroxylation metabolism, that is genetically determined in adults. New recommendations for use of this drug are proposed.

Adolescent↗

Oxaflozane overdose in a child.

A case of severe poisoning in a 2 year-old child who ingested 150 mg of oxaflozane, a non-tricyclic antidepressant, is reported. After loss of consciousness, opisthotonos and coma, recovery was obtained with conservative treatment. Atropine-like symptoms were noted. The maximal plasma concentration of oxaflozane was 63 ng/mL. The elimination half-life for N-dealkyloxaflozane was 4.8 h.

Antidepressive Agents↗

Seizure with hyponatremia in a child prescribed desmopressin for nocturnal enuresis.

We report a case of hyponatremia associated with a grand mal seizure in a 28 month-old child after intra-nasal desmopressin administration for high fluid intake with nocturnal enuresis. In view of the temporary symptomatic action and the seriousness of certain side-effects of desmopressin we recommend that desmopressin be used with caution in childhood enuresis.

Administration, Intranasal↗

Oxidative polymorphism of dextromethorphan in a Burundi population.

The wide availability, metabolism by the same cytochrome P450 as debrisoquine and, above all, the inocuity of dextromethorphan (DMP) favour the frequent choice of this drug as the test substance in determining oxidation phenotypes. 100 healthy Burundian volunteers (94 m and 6 f) in this study ingested 50 mg DMP bromhydrate, i.e. 38.5 mg of DMP base. Urine was collected for 8 h following the dose and TLC was used to analyse it. The method was particularly useful in view of its low cost, speed and the ease of applying it to a large study group. 5% of the Burundian subjects were poor metabolizers.

Adult↗

Characteristics of medication errors in pediatrics.

A six-month prospective study was carried out by 16 poison control centers in France to assess the epidemiology of medication errors in pediatrics. In this study, 1108 medication errors were analyzed. Mean population age was 3.2 years (median 2 years, range 3 days-15 years), and 30 percent of the children were under 1 year of age. The most frequent error characteristics were family responsibility, 87 percent (a member of the patient's family most often committed the error in medication use); parental prescribing decision, 31.5 percent (medication administered to the child by the parents without medical consultation or the advice of a pharmacist); incorrect execution of the prescription by the parents, 30 percent (error in dispensing, route of administration, etc.); oral forms, 52 percent (errors occurred most frequently with oral as opposed to other forms); incorrect dosage, 31.5 percent; and drug error, 30 percent (the drug dispensed was not the one prescribed). Iatrogenic injury occurred in 186 patients (17 percent) and 161 were hospitalized (15 percent). The majority of these were for surveillance only. The clinical outcome caused by medication error was unfavorable in two cases. The types of drugs most frequently misused included morphinic cough suppressants (9.5 percent), salicylates (9.1 percent), and ear, nose, and throat drops (9 percent); 459 proprietary medicines were specified. Prevention of medication errors should involve certain main requirements: formulations and package instructions specific to pediatric patients to ensure appropriateness and accuracy, detailed information given to patients by physicians and pharmacists about their prescriptions, and more public information concerning the risks of remedies or medication administered to children by parents who do not seek medical advice.

Adolescent↗

The use of flumazenil in a neonate.

Side effects of benzodiazepines used during pregnancy are described in a neonate. Recurrent apnea was reversed after administration of flumazenil, a specific antagonist of benzodiazepines.

Apnea↗