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【drug-news】WHO儿童标准处方集[精华]
儿科药物治疗的影响因素
Medicines in children
儿童用药
It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life—the sick, the needy and the handicapped.1
有人说过对于政府的道德的考验是政府如何对待处于黎明中的生命--儿童，处于黄昏的生命--老年人和处于阴影中的生命--病人，穷人和残疾人。
Children are among the most vulnerable individuals in any society. Nowhere is this more true than
in their access to appropriate health care. As part of the treatment of children, health-care workers
need access to drug dosage information. This formulary aims to provide that information universally, to assist in the management of children.
在任何社会中，儿童都是最有价值的成员。让儿童获得适当的健康关照是最有价值的。作为儿童治疗的一部分，医务工作人员需要获得儿童药物剂量方面的信息。本处方集是为儿童用药提供相关信息。
The use of medicines in infants and children presents a unique set of challenges to the prescriber. Physiological variances between children and adults, including the ontogeny of organ maturity and body composition, significantly influence the actions, effectiveness and safety of medicines. However, most pharmacokinetic and pharmacodynamic studies provide little, if any, information on drug action in infants and children, because they are usually conducted in adults.
婴儿和儿童用药对处方提出了一些列独特的挑战。儿童和成人之间存在生理差异，包括器官成熟和身体组成存在个体差异，这些因素会显著影响药物的作用、疗效和安全性。然而大多数药物的药代动力学和药效学都是在成人中进行的研究，对婴儿和儿童用药的相关药学信息提供非常少。
Paediatric pharmacology developed initially from the extrapolation of therapeutic practice and
experience in adults and the use of “scaled down” adult doses. This practice is clinically successful for the majority of drugs which are relatively non-toxic and have a wide margin between therapeutic and toxic doses. Drugs with a narrow therapeutic margin, such as the aminoglycoside antibiotics and digoxin, require more sophisticated knowledge and individualized dosage regimens. Doses of such agents are scaled by weight or allometrically (wt?), then modified according to the results of serum drug concentration measurements, if these are available. Over the last two decades, there has been an increased recognition of the necessity to perform studies specifically in children and adolescents. Major national and international approaches, such as those of the European Union and the United States, have resulted in some new information to improve the use of medicines in children.
儿科药理学最初从成人治疗经验和实践中外推发展而来，通过减少成人药物的剂量来用于儿童用药。对于那些无毒的和治疗剂量与毒性剂量差别大的药物在临床实践中大多数是成功的。对于那些治疗窗窄的药物，例如氨基糖苷类抗生素和地高辛，需要更复杂的知识和个性化的给药。这些药物需要按照体重或者allometrically(体重3/4)给药，然后如果可能的话，根据血药浓度监测来调整剂量。在过去的二十年中，对于儿童和青少年的用药需要进行研究的必要性开始被认识，主要的国家和国际组织，例如美国和欧盟对儿童用药已经提供了新的信息。
This formulary is the result of the establishment of the WHO Model List of Essential Medicines for Children (EMLc). The list can be accessed at http://www.who.int/selection_medicines/en/.
本处方集是世界卫生组织儿童基本药物标准目录建立后的成果。该基本药物目录见http://www.who.int/selection_medicines/en/
WHO儿童处方集.PDF (2885.32k) 在线查看 Absorption
吸收
Oral absorption
口服吸收
The gastrointestinal tract, particularly the stomach, undergoes significant changes from birth until around 3 years of age. Before then, the stomach has low levels of acid, and acid-labile drugs, such as the penicillins, show enhanced absorption. On the other hand, this depressed level of acidity may result in reduced absorption of weak acids such as phenobarbitone, phenytoin and rifampicin. The incomplete absorption experienced with these anticonvulsants may necessitate their continued parenteral administration.
胃肠道，特别是胃，从出生到三岁会发生明显的改变。在三岁以前，胃酸分泌处于低水平，对酸不稳定的药物，例如青霉素的吸收会增强。另一方面，胃中胃酸少会减少对弱酸性药物，例如苯巴比妥、苯妥英和利福平的吸收。对抗癫痫药物的不完全吸收可能对这类药物需要持续的经过非胃肠道方式给药
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作者:admin@医学,生命科学 2010-12-28 12:22
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