Drug development pediatric medications

There are many pediatric medical, nursing, and pharmacy journals that include articles on pediatric drug therapies (Table 2). Pediatrics, the journal of the American Academy of Pediatrics (AAP), and the Journal of Pediatrics are considered by most pediatric practitioners to be the top in the field. Pediatrics is of particular use to clinicians because it includes the policy statements developed by the AAP. These statements are considered to represent standards of practice by pediatricians. Many of these statements are also of interest to clinical pharmacists, such as the yearly schedule for routine childhood immunizations. Other AAP policy statements of note include recommendations on the administration of medications during breastfeeding, the ethical treatment of children enrolled in clinical research trials,and methods to reduce medication errors in the pediatric inpatient setting. The Journal of Pediatrics has also published useful practice recommendations, such as the guidelines for antithrombotic therapy.The pediatric journal for the American Medical Association, Archives of Pediatrics and Adolescent Medicine, often contains large-scale sur-... 

Several problems unique to pediatric drug therapy deserve special mention. For example, most medications are commercially available only in adult dose forms. Preparing pediatric doses from adult tablets or capsules can be very difficult and may require special skill on the part of the pharmacist. For some drugs it is simpler to administer the intravenous (IV) preparation orally than to develop a preparation from the oral medication. 

Recommendations may change, as resistance to all available drugs is increasing. See text for additional information on toxicities and cautions. For additional details and pediatric dosing, see CDC guidelines (phone 877-FYI-TRIP http //www.cdc.gov). Travelers to remote areas should consider carrying effective therapy (see text) for use if they develop a febrile illness and cannot reach medical attention quickly. 

Many drugs can now be delivered rectally instead of by parenteral injection (intravenous route) or oral administration. Generally, the rectal delivery route is particularly suitable for pediatric and elderly patients who experience difficulty ingesting medication or who are unconscious. However, rectal bioavailabilities tend to be lower than the corresponding values of oral administration. The nature of the drug formulation has been shown to be an essential determinant of the rectal absorption profiles. The development of novel absorption enhancers with potential efficacy without mucosal irritation (low toxicity) is very important. The delivery of peptide and protein drugs by the rectal route is currently being explored and seems to be feasible. 

An asthma DM program can assist pharmacists in providing education to patients with asthma. Hunter and Bryant developed an educational intervention administered by pharmacists and targeted at pediatric asthma patients and their parents. The educational intervention consisted of a 45-min presentation, a demonstration of drug delivery devices, and a discussion session for participants to ask questions and share experiences. All the participants indicated on a questionnaire that they had received enough information to safely and effectively administer asthma medications. 

To better understand changes in drug disposition, the pediatric population needs to be categorized into various groups (Table 1) because children vary markedly in their absorption, distribution, metabolism, and elimination of medications. This occurs because neonates, infants, children, adolescents, and adults have different body compositions (i.e., as to their percentages of body water and fat) and have their body organs in different stages of development. 

The percutaneous (transdermal or topical) route for systemic drug delivery is used infrequently for pediatric patients. Medications are typically applied to the skin for their local effect. In the future, this route may be used more frequently for systemic effects as more transdermal systems are developed for drug delivery. 

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