Improving Patient Education and Reducing Risk

Marcia L. Buck, Pharm.D., FCCP

Pediatr Pharm. 2001;7(7) 

In This Article

Pharmacology Literature Review

While the development of metabolic pathways for caffeine has been studied by many investigators, controversy remains over which patient variables are most likely to predict changes in metabolism. In one of the largest studies published to date, these authors report the results of monitoring metabolite production in 80 premature infants. Patients were stratified by birthweight, weight at enrollment, postnatal age, postconceptional age, and gestational age. Multivariate linear regression revealed a significant relationship only between demethylation and postnatal age, suggesting that this variable is the most predictive of maturation of the metabolic process. Al-Alaiyan S, Al-Rawithi S, Raines D, et al. Caffeine metabolism in premature infants. J Clin Pharmacol 2001;41:620-7.

Nitrofurantoin remains one of the most commonly prescribed antibiotics for treating urinary tract infections. While the American Academy of Pediatrics considers nitrofurantoin to be "usually compatible with breastfeeding," it is known to cross into breastmilk. In this evaluation of 4 women, serial milk and serum samples were analyzed following a single 100 mg oral dose to evaluate transfer into breastmilk. The observed milk to plasma ratio was 6.21±2.71, with a maximum concentration of 1.3 mg/L in the milk. The authors recommend that nitrofurantoin not be used in mothers with infants less than 1 month and that older infants be monitored for anemia resulting from unrecognized glucose-6-phosphate deficiency. Gerk PM, Kuhn RJ, Desai NS, et al. Active transport of nitrofurantoin into human milk. Pharmacotherapy 2001;21:669-75.