Pediatric Pharmacology

dr. Putrya Hawa, M.BiomedFaculty of Medicine, UII

Pediatric…

• ↑ In topical administrationSkin barrier

• ↑ in i.m administration toxicity↓ Muscle mass, peripheral blood flow

Liver blood flow

Pharmacodynamic

• Immature neuromuscular junction curare, atracurium

Drug Dosage

Pediatric dose:1.Based on body weight2.Young Formula

: adult dosage x age (years)age + 12

3.Clark’s Formula: adult dose x weight (kg)

70

Example: Neonatal Sepsis

• Leading cause of mortality in premature neonates

• Causes: Group B strep, E.coli, Klebsiella,rare but serious Listeria monocytogenes

• Empiric therapy: ampicillin and gentamicin• Safe, inexpensive, well studied

Gentamicin

• Water-soluble with a large volume of distribution

• Approximately 0.6 L/kg in neonate versus 0.25 L/kg in an adult

• Renal elimination slower than adult• Half-life 3-10 hours in a neonate, compared to 1-2 hours in an adult

Gentamicin (Con’t)

• Target levels same as adults– Peak 4-8 mcg/mL, trough < 2 mcg/mL

• Infused over 30 minutes• Usual dose 2.5 mg/kg given every 8 to 36

hours• Interval determined by weight, gestational

age, and renal function

Extended Gentamicin Interval

• Doses of 4 mg/kg given once daily in larger newborns

• Limited data in newborns < 32 weeks GA• Risk for toxicity if unable to clear large initial

dose• Use with caution in infants with potential

renal impairment

Thank you…