Peer Comment 1c

Expectations (Taylene)

• Length: A minimum of 180 words, not including references
• Relate to another study/journal
• Citations: At least two high-level scholarly reference in APA from within the last 5 years

A healthy 2-month-old child was brought to your clinic by her parents. The child is a full-term infant with no concerns. Her exam is normal, and she received her Hep B #1 in the nursery.

• Q1. What vaccines does she get? What combinations are available at your clinic?
  • According to the CDC, a 2-month-old infants should be getting rotavirus (RV1), diphtheria, tetanus & acellular pertussis (DTaP), haemophiles influenzae type b (Hib), pneumococcal conjugate (PCV13), inactive poliovirus (IPV) (2023). Vaxelis, is a combination of 6 vaccines, which are, DTaP, IPV, Hib, and Hep B (2019). This will mean the baby will only need to get the RV1 and the PCV13 which means 3 pokes instead of 6 which is much better for the child and the parents.
• Q2. The child returns at 12 months after completing her primary series of vaccines at 2, 4, and 6 months of age. Her vaccines are right on schedule, her parents have no concerns, she is developing normally, and her exam is normal. What vaccines can she get today?
  • The child can get the 3^rd dose of the HepB, 3^rd dose of Hib, 4^th dose of PCV13, and the 3^rd dose of IPV, according to the CDC vaccination schedule (2023). Optional vaccines include COVID 19 vaccination and the yearly flu vaccine if the parents want to take the additional vaccinations (2023).
• Q3. Which groups of patients are at higher risk for pneumococcal disease, and need PPSV23 early starting at 2-years old?
  • According to Kobayashi et al., children with any immunocompromised conditions: dialysis, nephrotic syndrome, congenital asplenia/splenic dysfunction, immunodeficiency, treatments with immunosuppressants, HIV, sickle cell diseases, heart disease, CKD, liver disease, lung disease, cochlear implants, DM, cerebrospinal fluid leaks or any decreased immune function (2022). They need two additional doses of the PPSV23 one at two years old and then 8 weeks later (2023).

A 25-year-old woman comes to your office asking for oral contraceptive refills. She stated that she was feeling depressed and heard about St. John’s wort used in depression which she started taking a week ago.

• Q4. How might concomitant administration of St. John’s wort affect the efficacy of drugs this patient is taking such as the oral contraceptives? Discuss another example of a possible drug interaction that might occur with St. John’s wort?
  • According to Canenguez Benitez et al., St. John’s wort has proven very effective treating mild to moderate depression but can have interactions with several other medications such as with oral contraception (2022). SJW can make oral contraception less effective, and she should expect more breakthrough bleeding and could possibly decrease the (Canenguez Benitez, 2022). Nicolussi et al., state almost 70% of the medications on the market will have interactions with SJW because they are metabolized by the liver, on example is Xanax (2020). They go on to say it causes an increase in Xanax clearance in the body and it will be less effective and need higher doses of the medication for it to be effective (Nicolussi et al., 2020).

The 25-year-old woman stated that her 4-year-old child has been coughing and sounds congested. She wants to know if echinacea might help her child.

• Q5. What is echinacea used for and how is it taken?
  • Echinacea is an anti-inflammatory herb used to treat upper respiratory infections in children and adults. Weishaupt et al., did a study on children taking echinacea tabs and how it impacted their cold symptoms, the study showed a reduction of symptoms of 2 to 3 days (2020). Echinacea can be used to treat many different types of illnesses or inflammatory conditions. It can be found in tea, liquid, cough/cold medicines, and pills depending on how the patient wants to take the herb.
• Q6. Is it safe for this mother to give her child echinacea?
  • It is safe for her child to taken echinacea, but she needs to be educated on dosing and making sure she is using “children” dosing and medications. Herbs and other herbal supplements are not regulated by the FDA and can contain other ingredients that cannot be proven to be safe for children so herbal supplements should be closely evaluated and taken for short terms and with great caution. As long as the patient’s mother is aware of the risks and has been properly educated, echinacea can be used with great effect at reducing cold symptoms for her child.

References

Canenguez Benitez, J. S., Hernandez, T. E., Sundararajan, R., Sarwar, S., Arriaga, A. J., Khan, A. T., Matayoshi, A., Quintanilla, H. A., Kochhar, H., Alam, M., Mago, A., Hans, A., & Benitez, G. A. (2022). Advantages and Disadvantages of Using St. John’s Wort as a Treatment for Depression. Cureus, 14(9), e29468. https://doi.org/10.7759/cureus.29468

Centers for Disease Control and Prevention. (2019, August 1). About combination vaccines for children. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/why-vaccinate…

Centers for Disease Control and Prevention. (2023, April 27). Birth-18 years immunization schedule – healthcare providers. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/schedules/hcp/imz/chi…

Kobayashi, M., Farrar, J. L., Gierke, R., Britton, A., Childs, L., Leidner, A. J., Campos-Outcalt, D., Morgan, R. L., Long, S. S., Talbot, H. K., Poehling, K. A., & Pilishvili, T. (2022). Use of 15-valent pneumococcal conjugate vaccine and 20-valent pneumococcal conjugate vaccine among U.S. adults: Updated recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR. Morbidity and Mortality Weekly Report, 71(4), 109–117. https://doi.org/10.15585/mmwr.mm7104a1

Nicolussi, S., Drewe, J., Butterweck, V., & Meyer Zu Schwabedissen, H. E. (2020). Clinical relevance of St. John’s wort drug interactions revisited. British journal of pharmacology, 177(6), 1212–1226. https://doi.org/10.1111/bph.14936

Weishaupt, R., Bächler, A., Feldhaus, S., Lang, G., Klein, P., & Schoop, R. (2020). Safety and dose-dependent effects of echinacea for the treatment of acute cold episodes in children: A multicenter, randomized, open-label clinical trial. Children, 7(12), 292. https://doi.org/10.3390/children7120292