Handbook of Experimental Pharmacology Pediatric Clinical Pharmacology 2018
Handbook of Experimental Pharmacology Pediatric Clinical Pharmacology 2018 A safe and effective medication for children requires a fundamental understanding and integration of the role of ontogeny in the disposition and actions of medicines. As the most fundamental prerequisite, one has to consider the basic principle that children are not small adults!
The German-American and father of American pediatrics, Abraham Jacobi (1830–1919), recognized the importance of and the need for age-appropriate pharmacotherapy when he emphasized: “Pediatrics does not deal with miniature men and women, with reduced doses and the same class of disease in smaller bodies, but … has its own independent range and horizon” (Kearns et al. 2003).
Along that line of argumentation some years later the German pioneer of pediatric pharmacology, Rudolf Fischl (1862–1942), wrote: “Die Therapie des Kindesalters bedeutet nicht lediglich eine Restriktion der Behandlung der Erwachsenen, sondern baut sich auf genaue Kenntnisse der Physiologie dieser Lebensepoche auf” (Fischl
1902). Moreover, he stated: “Viel Ungluck€ hat schon die Mathematik in der Medizin angerichtet, und eine einfache Berechnung der sogenannten refrakten Dosen furdas Kindersalter aus der Gewichtsdifferenz konnen€ leicht ebenfalls ein solches anrichten” (Fischl 1902). Harry Shirkey (1916–1995), the well-known American pharmacist and pediatrician, wrote in his textbook on Pediatric Therapy with other words.
The long list of dosage rules based on age, body weight or surface and their respective authors is testimony that no rule is entirely satisfactory in producing an exact fraction of the known adult dose that is applicable to a particular child”
(Shirkey 1975). This fundamental knowledge of determining the pediatric dosage of a medicine is even today – 100 years later – often ignored. Thus, as the first step for a successful approach to pediatric therapeutics, one must appreciate the differences among pediatric subpopulations with their typical features and health problems and the nonlinear and dynamic process of maturation.
The ontogeny of basic physiologic processes provides guideposts for understanding the mechanisms underlying differences between different developmental stages within the pediatric and adult populations.