OPTIMAL PEDIATRIC PHARMACOTHERAPY: AN
INTERNATIONAL CHALLENGE
S. M. MacLeod
Pediatrics, Clinical
Epidemiology & Biostatistics, Hamilton, Canada, McMaster University
In developed countries, those who practice pediatric pharmacology are
often assailed with the argument that issues of therapeutics and toxicology
are less pressing in pediatrics because of relatively limited numbers of
recipients. While children, on average, require fewer drugs than those aged
over 65 it is clear that drug therapy is important in many areas of
pediatric practice such as neonatology, anesthesiology, neurology, and
infectious disease and that international reawakening of interest in
pediatric pharmacology following recent U.S.A. policy changes is welcome.
Since the passage of the FDA Modernization Act in 1998, there has been a
rising tide of child-focussed drug investigation building on efforts in the
United States to develop targeted pediatric pharmacology research
units. As it happens, most
beneficiaries of these efforts to ¡°deorphan¡± drugs for children are in the
developing world where national populations typically have 40-50% aged
below 15 yrs. Given these
demographic realities, it is critically important to coordinate international
efforts in pediatric pharmacology and to make sure that conditions common
in the developing world are not ignored in favour of a developed country
disease agenda. Unfortunately, health and medical research priorities are
mostly set in countries making up less than 25% of the world¡¯s population
but sponsoring more than 95% of the research. For full impact, pediatric
pharmacology must pioneer and advocate research methods to meet the
challenge of optimal therapy for special populations under developing world
conditions.
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influence of nutrition/micronutrients
on drug distribution and effect
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logistical challenges in
vaccine trials
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drug supply and drug
management challenges
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efficiency of informatic
interventions to improve therapy
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the continuing need to
combat communicable disease (HIV/AIDS/TB/ARI/Acute diarrhea/Tropical
diseases/emergent viruses)
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improving therapeutic access
in rural and remote areas
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toxicology/poisoning among
children
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assessment of natural health
products
It is time for individual pediatricians and for
those interested in pediatric clinical pharmacology to take the initiative
in demanding support for a comprehensive, multidisciplinary research
program to inform cost-effective drug therapy for children everywhere. The
question is not whether we should be involved. Rather we must ask whether
we can afford not to be involved.