Drug Therapy in

Pediatric Patients

Dwi Indria Anggraini; Maya Ganda Ratna

Department of Pharmacology and Pharmacy
Faculty of Medicine Lampung University
 Introduction
Lower biotransformation

and Infants
function of liver
Low plasma protein
Neonates and binding capacity
Undeveloped blood-brain
barrier
Low excretion function of
kidney
High receptor sensitivity
 Definition
Premature Baby born less than 37 weeks post
●

neonate conception

Neonate Baby less than 44 weeks post conception

●

Infant Child up to twelve months of age

●

Child Over 12 months of age up to adolescent

●
 Absorption

●
The gastric acid secretion ▼ in preterm infants.
●
Gastric emptying time is prolonged.
Oral Adm ●
Gut motility is irregular and may be slow.
●
GI enzyme activities tend to be lower.

●
Absorption in children is variable.
●
Is associated with variable plasma
Rectal Adm concentrations; factors such as variable lower
gastrointestinal motility and depth of insertion.
Source: Betram G. Katzung Basic & Clinical Pharmacology. 9 th ed.
 Absorption

●
Absorption is variable.
●
Depend on skin thickness and blood flow.
Transdermal Adm ●
Can cause systemic toxicity if topical preparations
(e.g. of potent CS) are applied too extensively

●
Depends mainly on the rate of blood flow to the muscle
or subcutaneous area injected
IM, SC Adm ●
Cardiovascular shock, vasoconstriction due to
sympathomimetic agents, and heart failure might reduce
blood flow (eg. aminoglycosida, and anticonvulsants)
 Distribution

Fluid distribution: the greatest change in body water compartments occurs in the
first year of life.

Water soluble drugs will have a greater volume of distribution in the neonate. (e.g.
aminoglycosides, theophylline)
Source: Skinner AV. Neonatal Pharmacology. Anaesthesia and Intensive Care
Medicine. 2010; 12(3):79-84.
Muscle and fat content as a proportion of total body mass is smaller in neonates
compared to older children. (e.g. diazepam, thiopentone)

Source: Skinner AV. Neonatal Pharmacology. Anaesthesia and Intensive Care

Medicine. 2010; 12(3):79-84.
 Plasma Protein Binding

Protein binding of drugs is reduced in the

neonate.

Lower plasma albumin concentration and altered

binding properties

Albumin binds to bilirubin.

 Blood Brain Barrier
• Neonates have an immature BBB >> more
permeable in neonates >> increased risk of CNS
AEs.
• This may be partly responsible for the
considerable neonatal sensitivity to the CNS
effects.
• Disease states such as sepsis, hypoxia and
acidosis further reduce the integrity of the BBB.
 Metabolism
• The ability of a neonate to metabolize drugs is
mainly dependent on hepatic blood flow and
enzyme maturation.
• Activities of the cyt P450-dependent mixed-
function oxidases and the conjugating enzymes
are substantially lower in early neonatal life
than later.
• Many drugs have slow clearance rates and
prolonged elimination half-lives.
Source: Skinner AV. Neonatal Pharmacology. Anaesthesia and Intensive Care
Medicine. 2010; 12(3):79-84.
Source: Betram G. Katzung Basic & Clinical Pharmacology. 9 th ed.
 Excretion
• The GFR is much lower in newborns than in
older infants, children, or adults.

Source: Skinner A. Paediatric Pharmacology. Locum Consultant in Paediatric

Anaesthesia. Bristol Royal Hospital for Children. 2013 (cited on 2013
May). Available from: -safe-anaesthesia.org.
Excretion

Source: Ritter JM, Lewis LD, Mant TGK, Ferro A. A Textbook of Clinical
Pharmacology and Therapeutics. 5 th ed. 2008.
Breast-feeding

Source: Ritter JM, Lewis LD, Mant TGK, Ferro A. A Textbook of Clinical
Pharmacology and Therapeutics. 5 th ed. 2008.
 Drug Therapy in Pediatric
Physiologic
processes
that
PD
influence PK
differences
variables in Therefore,
between
the infant need special
pediatric and
change attention to
other
significantly pharmacokin
patients have
in the 1st etics in this
not been
year of life, age group.
explored in
particularly
great detail
during the
1st few
months.
 Reference
1. Betram G. Katzung Basic & Clinical Pharmacology. 9th ed.
2. Ritter JM, Lewis LD, Mant TGK, Ferro A. A Textbook of
Clinical Pharmacology and Therapeutics. 5th ed. 2008.
3. Skinner A. Paediatric Pharmacology. Locum Consultant in
Paediatric Anaesthesia. Bristol Royal Hospital for Children.
2013 (cited on 2013 May). Available from: -safe-
anaesthesia.org.
4. Davis PJ. Pharmacology for Infants and Children. 2006 (cited
on 2013 May). Available from: researchgate.net.
5. Skinner AV. Neonatal Pharmacology. Anaesthesia and
Intensive Care Medicine. 2010; 12(3):79-84.
End.
THX U