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 worlds 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.

l          influence of nutrition/micronutrients on drug distribution and effect

l          logistical challenges in vaccine trials

l          drug supply and drug management challenges

l          efficiency of informatic interventions to improve therapy

l          the continuing need to combat communicable disease (HIV/AIDS/TB/ARI/Acute diarrhea/Tropical diseases/emergent viruses)

l          improving therapeutic access in rural and remote areas

l          toxicology/poisoning among children

l          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.

 

 
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