Pediatric groups adolescent

Vaccines are used in either the general population of children or adults or for special groups. Recommendations for vaccine usage are made by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control. The Committee on Infectious Diseases of the American Academy of Pediatrics (Redbook Committee) also makes recommendations for infants through adolescents, and the American Academy of Family Physicians makes recommendations for adults. An excellent review of vaccine history, development, usage, and related regulatory issues is available (2). 

Research Unit on Pediatric Psychopharmacology (RUH) Anxiety Study Group (2001) Flovoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 344 1279-1285. 

Brown Obsessive-Compulsive Scale [Y-BOCS] score) and excellent responders (defined as normalization = a Y-BOCS score of <10) in children and adolescents treated with sertraline (March et ah, 1998). The NNTs of 5 and 10, respectively, confirm the implications in the change in mean score in the sertraline group— namely, that an average 6-point Y-BOCS drop (a pre-to post-treatment drop from 24 to 18), which parenthetically is consistent across pediatric and adult OCD SSRl trials (Greist et ah, 1995 Leonard et ah, 1997), leaves most patients in the clinically ill range. 

The MAOIs have been found to be beneficial for patients who have not responded to other medications (Thase and Rush, 1997 APA, 2000). An open study suggested that adolescents with depression who did not respond to TCAs responded to MAOIs (Ryan et ah, 1988b). However, it is possible that these adolescents did not respond to TCAs because this group of medications is not efficacious for the treatment of pediatric MDD (Birmaher et ah, 1996a). 

Several controlled studies of IMI involved less homogeneous samples of anxious children. Neither IMI nor alprazolam (a BZ) was superior to placebo in an 8-week study of 24 children (ages 7-18 years) with school refusal, which included subjects with anxiety and depression (Bernstein et ah, 1990). A more recent placebo-controlled study of IMI -I- CBT for 47 adolescents (ages 12-18 years) with school refusal, anxiety, and/or depression was designed to address the limitations of previous studies of TCA treatment for pediatric anxiety disorders (Bernstein et ah, 2000). Accordingly, sample size was based on proposed power analysis IMI dose and serum level were monitored to ensure adequate exposure (mean IMI dose 180 mg/day mean serum IMI180 pg/L and mean IMI -I- DMI 250 pg/L at week 3 and week 8) and CBT was manual based and closely monitored. Fifty-four percent of subjects treated with IMI -I- CBT met remission criteria (defined as > 75% school attendance at the end of the study), compared to 17% of subjects treated with placebo -I- CBT. No between-group differences were noted... 

The clinical part of the study was conducted with participation of 116 adolescent patients aged from 10 to 18 years hospitalized by the Department of Pediatrics for examination and treatment of chronic dyspeptic complaints. The control group comprised 38 age matched healthy volunteers. The Regional Research Ethics Committee of Ukraine approved the study. 

Because CBZ and valproate have been used for many years to treat seizure disorders in children and adolescents, more systematic knowledge about their clinical pharmacology in this age group is available than there is about lithium. However, pediatric patients with epilepsy are often on concomitant therapy with other anticonvulsants. That fact complicates attempts to extrapolate from this experience to the use of CBZ or valproate as monotherapy for childhood or adolescent bipolar disorder. For example, the risk of serious and potentially fatal hepatotoxicity with valproate occurs almost exclusively in children younger than age 10 years (usually 2 years or younger) who are on multiple anticonvulsants for congenital seizure disorders. How or whether this risk translates to children or adolescents who are on monotherapy with valproate for bipolar disorder is unknown. Nonetheless, clinicians need to be aware of this possible risk and take the following steps to increase the likelihood of early detection in case this problem arises ... 

Diabetes Control and Complications Trial Research Group (1994) The effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus. journal of Pediatrics 125 177-188. 

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. 

Perry HE, Wright RO, Shannon MW, Woolf AD. Baclofen overdose drug experimentation in a group of adolescents. Pediatrics 1998 101(6) 1045-8. 

Lopez MJ, Oyarzabal M, Rodriguez M, Barrio R, Hermoso F, Blasco L. Severe hypoglycemia in Spamsh diabetic children and adolescents. Study Group of imantile Diabetes of the Spanish Paediatric Endocrinology Society. J Pediatr Endocrinol Metab 1999 12(l) 85-7. 

Schober E, Schoenle E, Van Dyk J, Wernicke-Panten K Pediatric Study Group of Insulin Glargine. Comparative trial between insulin glargine and NPH insulin in children and adolescents with type 1 diabetes. Diabetes Care 2001 24(ll) 2005-6. 

Rectal administration The administration of drugs by a solid rectal dosage form (i.e., suppositories) can result in a wide variability in the rate and extent of absorption in children (79). Rectal administration of a drug is not favored by adolescents, carers, and various ethnic groups and can sometime be difficult (premature loss of the dose) in the very young. These facts, coupled with the inflexibility of a dose, make this a route difficult to promote for pediatric patients with chronic conditions. Nevertheless it can be an alternative route if the oral route is not available or local effects or immediate systemic effects (epileptic seizures) are required. 

Annand KHS and International Evidenced Based Group for Neonatal Pai n. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001 155 173—180. 

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