Abstract
Many physiologic differences between children and adults may result in age-related changes in pharmacokinetics and pharmacodynamics. Factors such as gastric pH and emptying time, intestinal transit time, immaturity of secretion and activity of bile and pancreatic fluid among other factors determine the oral bioavailability of pediatric and adult populations. Anatomical, physiological and biochemical characteristics in children also affect the bioavailability of other routes of administration.Key factors explaining differences in drug distribution between the pediatric population and adults are membrane permeability, plasma protein binding and total body water. As far as drug metabolism is concerned, important differences have been found in the pediatric population compared with adults both for phase I and phase II metabolic enzymes. Immaturity of glomerular filtration, renal tubular secretion and tubular reabsorption at birth and their maturation determine the different excretion of drugs in the pediatric population compared to adults.
Highlights
The statement that children are not small adults is valid in pediatric clinical pharmacology
We review the way pharmacokinetic parameters are affected through the development and maturing process in children, which determine the disposition of drugs and the necessity to carry out specific studies in the different pediatric ages and to establish particular dosification steps in the pediatric population
Intramuscular administration of drugs is unreliable in neonates and the pharmacokinetics are unpredictable, for drugs such as aminoglycosides and ampicillin, the time needed to achieve peak concentration is comparable for infants, children and adults when administered by intramuscular route [18,19]
Summary
The statement that children are not small adults is valid in pediatric clinical pharmacology. The application of pharmacokinetic and pharmacodynamic knowledge to the pediatric field implies the understanding of the maturing process in a continuing changeable organism at every age, from preterm neonates to adolescence. Pharmacokinetics studies the passage of the drugs through the organism, this means liberation, absorption, distribution, metabolism and excretion (LADME). Anatomical, physiological and biochemical changes that occur from birth affect pharmacokinetics/pharmacodynamics and the bioavailability of drugs. We review the way pharmacokinetic parameters are affected through the development and maturing process in children, which determine the disposition of drugs and the necessity to carry out specific studies in the different pediatric ages and to establish particular dosification steps in the pediatric population
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