Pediatric serum drug concentrations

Important Differences in Pediatric Serum Drug Concentrations... 

Kraus, D.M. Calligaro, I.L. Hatoum, H.T. Multilevel model to assess appropriateness of pediatric serum drug concentrations. Am. J. Dis. Child. 1991, 145, 1171-1175. 

In 1998, Rachl et al. published the results of the 1995 National Clinical Pharmacy Services study that determined the extent of hospital-hased clinical pharmacy services in 1109 U.S. acute care, general, medical-surgical, and pediatric hospitals with 50 or more licensed beds. Pharmacokinetic consultations (i.e., pharmacist review of the serum drug concentration datti and patient medical record with appropriate verbal or written follow... 

Serum drug concentrations should be monitored for drugs with narrow therapeutic indices and ehminated largely by the kidney (e.g., aminoglycosides and vancomycin) to optimize therapy in pediatric patients with renal dysfunction. For drugs with wide therapeutic ranges (e.g., penicillins and cephalosporins), dosage adjustment may be necessary only in moderate to severe renal failure. 

Adverse reactions to drugs differ in both type and incidence in the pediatric population. Because of immature metabolic pathways, infants and children may have different metabolic patterns than adults. This at least partially explains why neonates require lower theophylline serum concentrations for the treatment of neonatal apnea and why the incidence of hepatotoxi-city following acetaminophen overdose is much lower in young children than in adults [44,45]. Antibiotic adverse effects unique to the pediatric population may... 

Table 2 gives therapeutic serum concentrations and pharmacokinetic information for some drugs administered to pediatric patients. 

Serum concentration monitoring of various drugs administered to pediatric patients may appropriately give information about the drug but not its metabolites. This may be a problem when children metabolize specific drugs differently than adults with resulting differences in metabolite concentrations or the presence of different metabolites. This has been noted when premature infants... 

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