Pediatrics

Emergence of resistant pathogens emphasizes the need for alternatives to antimicrobial agents for acne therapy. We can compound cosmetically-appealing customized formulations which can contain numerous medications to provide a synergistic effect for treatment of resistant acne.

Int J Dermatol. 1995 Jun;34(6):434-7.. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris..

J Dermatol. 1996 Apr;23(4):243-6.. Topical spironolactone reduces sebum secretion rates in young adults..

The use of medications to treat ADHD has greatly increased, yet the dosage requirements for many children differ from strengths that are commercially available. This often necessitates a midday dose at school, which can be embarrassing to a child. Slow-release dosage forms can be compounded to contain the precise dose of medication needed by each child.

Amino acid, nutritional, chelation, and supplemental therapies can be customized for each child. Transdermal options exist.

Customized formulations containing protectants, absorbents, and bile acid sequestrant can provide relief for irritated skin. We can also compound medications, such as cholestyramine ointment, to prevent site irritation in ostomy patients.

Ann Pharmacother. 1996 Sep;30(9):954-6.. Cholestyramine ointment to treat buttocks rash and anal excoriation in an infant..

Athlete’s foot, jock itch, and onychomycosis (fungal nail) are common, particularly in athletes. Research points to the practicality “of using ibuprofen, alone or in combination with azoles, in the treatment of candidosis, particularly when applied topically, taking advantage of the drug’s antifungal and anti-inflammatory properties.” Various synergistic combinations are used for antifungal therapy.

J Med Microbiol. 2000 Sep;49(9):831-40.. Antifungal activity of ibuprofen alone and in combination with fluconazole against Candida species..

Concerns about emerging resistance and the potential harm of using permethrins have prompted a search for effective pediculicidal therapies that are not harmful to children with repeated use. An herbal formulation has been shown to be effective for head lice.9 Ivermectin can also be compounded for topical application or as an oral dose titrated for each patient for the treatment of head lice and scabies.

Clin Exp Dermatol. 2002 Jun;27(4):264-7.. Treatment of 18 children with scabies or cutaneous larva migrans using ivermectin..

Trop Med Parasitol. 1994 Sep;45(3):253-4.. Efficacy of ivermectin for the treatment of head lice (Pediculosis capitis)..

J Dermatol. 2001 Sep;28(9):481-4.. Oral ivermectin in scabies patients: a comparison with 1% topical lindane lotion..

Isr Med Assoc J. 2002 Oct;4(10):790-3.. The in vivo pediculicidal efficacy of a natural remedy..

Resistant warts and molluscum contagiosum have been treated successfully with compounded topical medications, avoiding discomfort associated with freezing, scraping, electrocautery and laser therapy.

The following study found that 5% KOH aqueous solution proved to be as effective and less irritating when compared to the 10% KOH solution. This trial also emphasizes the effectiveness of topical KOH in the treatment of molluscum contagiosum, sparing affected children from more aggressive physical modalities of treatment.

Pediatr Dermatol. 2000 Nov-Dec;17(6):495.. Evaluation of the effectiveness of 5% potassium hydroxide for the treatment of molluscum contagiosum..

Orally administered anti-emetics can be difficult for a nauseated child to “keep down”, and rectal suppositories may not be well accepted by children. Even persistent nausea can often be effectively controlled by using a combination of medications tailored to meet an individual’s specific needs. Dosage forms include transdermal gels, suppositories, lollipops, and more.

Promethazine is commonly compounded for topical or transdermal application to treat nausea, vomiting, and vertigo, but this preparation may be used as an antiemetic for cases ranging from chemotherapy to motion sickness. The dose is typically 25mg for adults, and the dose is decreased for children. The gel is applied to an area of soft skin, such as the inside of the wrist or arm, the side of the torso, or the inside of the thigh. For children, doses are often applied to the inside of one wrist, and then the wrists are rubbed together.

Topical anesthesia is needed for common pediatric procedures such as suturing, wound cleaning, and injection administration. The ideal topical anesthetic would provide complete anesthesia following a simple pain-free application, not contain narcotics or controlled substances, and have an excellent safety profile. The combination of topical anesthetics lidocaine and tetracaine and the vasoconstrictor epinephrine has been used successfully for anesthesia prior to suturing linear scalp and facial lacerations in children. A triple-anesthetic gel containing benzocaine, lidocaine, and tetracaine (“BLT”) has also been reported to be effective when applied prior to laser and cosmetic procedures. Convenience of application without need for occlusion is an advantage of these topical anesthetics.

The following article concludes: “LAT gel (4% lidocaine, 1:2000 adrenaline, 0.5% tetracaine) worked as well as TAC gel (0.5% tetracaine, 1:2000 adrenaline, 11.8% cocaine) for topical anesthesia in facial and scalp lacerations. Considering the advantages of a noncontrolled substance and less expense, LAT gel appears to be better suited than TAC gel for topical anesthesia in laceration repair in children.”

Pediatrics. 1995 Feb;95(2):255-8.. Lidocaine adrenaline tetracaine gel versus tetracaine adrenaline cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years..

Sildenafil has the potential to improve hemodynamics and exercise capacity for up to 12 months in children with Pulmonary arterial hypertension (PAH), and this medication can be compounded as a stable oral suspension.

Circulation. 2005 Jun 21;111(24):3274-80. Epub 2005 Jun 13.. Beneficial effect of oral sildenafil therapy on childhood pulmonary arterial hypertension: twelve-month clinical trial of a single-drug, open-label, pilot study..

Am J Health Syst Pharm. 2006 Feb 1;63(3):254-7.. Extemporaneous sildenafil citrate oral suspensions for the treatment of pulmonary hypertension in children..