Patient compliance pediatric patients

Injections are unpleasant and patient acceptance and compliance via this route are low. Intravenous injections may only be given by qualified medical professionals, making this route expensive and inconvenient. Intramuscular and subcutaneous preparations are self-injectable however, patients dislike them. In addition, elderly, infirm and pediatric patients cannot administer their own injections and require assistance, thereby increasing inconvenience to these patients and the cost of their therapy. Increased medical complications can result from the poor compliance associated with the parenteral route. 

The goals of management are to maintain pulmonary compliance and promote chest wall and lung growth (in pediatric patients), to maintain normal alveolar ventilation, and to maximize CPF. 

All patients and parents of children with SCD should have a plan for what to do in the event of symptoms of infection or pain. Obtain a medication history when patients are admitted to the hospital. Assess compliance with prophylactic penicillin and childhood immunization schedules in all pediatric SCD patients. 

Beck, D.E. Fennell, R.S. Yost, R.L. Robinson, J.D. Geary, D. Richards, G.A. Evaluation of an educational programme on compliance with medication regimens in paediatric patients with renal transplants.. 1. Pediatr. 1980, 96, 1094. 

Interpatient variability in the pharmacokinetics of oral methotrexate and mercaptopurine may also be an important determinant of the effectiveness and toxicity of maintenance therapy. Patients who take their oral methotrexate and mercaptopurine on an evening versus a morning schedule appear to have a superior outcome. To account for the interpatient variability, most pediatric protocols titrate the dose of either agent to maintain an absolute neutrophil count of 750 to 1,500/rmn. Some protocols circumvent bioavailabihty and poor compliance issues by administering methotrexate parenterally. The importance of these pharmacokinetic issues in adults is less well defined. 

---