Improving Medicine Use for Children: A Global Imperative

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Any consideration of future directions for the disciplines of pediatric clinical pharmacology and clinical pharmacy must consider changing therapeutic priorities in child health and the resulting implications for related clinical and scientific disciplines.1 Equally and critically important is the unbalanced distribution of the world's population of children under the age of 14. World Bank data show that birthrates are declining in many countries but the pediatric population worldwide is still increasing rapidly, particularly in sub‐Saharan Africa and in most low‐ and lower‐middle‐income countries. The burgeoning child population in such areas will amplify the need for carefully targeted research, education, and clinical services that can be provided by individuals specifically trained to make optimal pediatric therapeutics a focus of their professional activities.
In 2015, of the world's 7.34 billion citizens, 26% (1.91 billion) had not yet reached their 14th birthday. The child population is not, however, symmetrically distributed and varies across levels of national economic development, ranging from 43% in low‐income countries and 31% in lower‐middle‐income countries to 17% in high‐income countries. Nonetheless, children in all circumstances remain united by their right to scientifically validated, safe, and effective medicinal therapy. Regrettably, such an entitlement has been inadequately fulfilled during the past 50 years. While higher and higher standards have been applied to the evaluation of new therapies for adults, beginning with small molecule drugs and progressing to more precisely targeted complex biological products, children have commonly been left dependent on often inappropriate extrapolation of therapeutic choice and dosing guidelines. Such an inequitable approach to evidence‐based treatment should be viewed as unacceptable by all professionals committed to optimal medical care of children.
In part as a consequence of pediatric clinical pharmacology's deficient research base, the world's children have borne a heavy burden of illness and have often been deprived of access to treatments anticipated to be safe and effective. Especially in low‐ and lower‐middle‐income countries, rates of neonatal, infant, and under‐5 mortality remain at high levels, even though most of the well‐documented commoner causes of death would be amenable to evidence‐based drug therapies or effective preventive measures.
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