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Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

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Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
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Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

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Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
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Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

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Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
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Pediatric ALL Treatment Modifications in Low- and Middle-Income Countries: A Systematic Review.

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Pediatric acute lymphoblastic leukemia (ALL) treatment regimens in low- and middle-income countries are frequently adapted due to implementation barriers. Modified regimens showed higher survival rates, highlighting the need for better outcome reporting.

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Area of Science:

  • Pediatric Oncology
  • Global Health
  • Implementation Science

Background:

  • Treatment regimens for childhood acute lymphoblastic leukemia (ALL) in low- and middle-income countries (LMICs) often require adaptation.
  • The clinical impact and common modifications of these adapted regimens are not well understood globally.

Purpose of the Study:

  • To examine pediatric ALL treatment regimens used in LMICs.
  • To identify patterns of adaptation and barriers affecting global ALL care delivery.
  • To describe the range of outcomes associated with adapted regimens.

Main Methods:

  • A systematic review adhering to PRISMA guidelines was performed across seven databases.
  • Data from 2000-2021 on ALL regimens in LMICs were analyzed, focusing on geographic distribution, backbone adoption, modifications, and outcomes.
  • Descriptive statistics were used to summarize article characteristics.

Main Results:

  • 125 articles detailing 163 regimens across 36 countries were included; 84.6% used high-income regimens as a backbone.
  • 64% of regimens were adapted, with the most common change being the reduction/omission of high-dose methotrexate.
  • Implementation challenges (drug access, cost) were more frequent reasons for modification than toxicity, yet implementation outcomes were rarely measured (6.4%).
  • Five-year overall survival was significantly higher in modified versus unmodified regimens (P = .030).

Conclusions:

  • Implementation barriers are the main drivers for ALL regimen adaptations worldwide.
  • A significant gap exists in the literature regarding the reporting of implementation outcomes for adapted regimens.
  • Integrating implementation science is crucial for effective delivery of innovative ALL treatments in diverse resource settings.