Paediatric pharmacy - drug therapy
Safe and effective drug treatment for children requires an understanding of the wide variability and constant changes in pharmacokinetic handling and pharmacodynamic response to drugs that occur during the time from birth to adulthood.
An awareness of, and empathy with, the problems and challenges of drug administration throughout childhood is essential if the pharmacist is to be competent and confident in becoming part of the multidisciplinary team caring for paediatric patients and their families.
Children are not just “small adults”, particularly when drug handling is considered; children are not “just children” either. Patients range from premature babies, born as early as 24 weeks gestation, to 18-year-old adolescents. They suffer from cardiac, respiratory, renal, and other system diseases, in the same way as adults. The “specialist” paediatric pharmacist usually also has to be a “generalist”.
Recently, there has been international agreement on age groups to be used when considering medicines for children1 (see Panel 1, p 50). These age groups are aimed at the pharmaceutical industry to help rationalise the licensing of medicines for children. They will avoid product licences having recommendations based on age bands, which have sometimes appeared to be arbitrarily chosen rather than being based on relevant physiological and pharmacokinetic principles.
The altered pharmacokinetic handling of medicines seen at the different stages of childhood development gives rise to practical problems in drug absorption and distribution.
Absorption — oral
At birth, gastric pH is between 6 and 8. Other than a small lowering, it remains relatively high until gradually falling to adult levels by the age of two or three years.
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Citation: Hospital Pharmacist URI: 10976666
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