Therapeutic drug monitoring in pediatrics: how do children differ?

The science of therapeutic drug monitoring in children remains relatively underdeveloped. This is in part attributable to the continuing neglect of issues in pediatric pharmacology/toxicology and pharmacy during the past 50 years when the overall pace of change in other areas of therapeutics has been dramatic. For a variety of reasons, children have not participated in or received all the benefits of clinical progress in treatment and understanding of drug toxicity. In 1968, Dr. Harry Shirkey coined the phrase "therapeutic orphans" to describe the situation of infants, toddlers, and children who, in his view, were being denied access to modern drug therapy. Most authors have attributed this orphan status to the shortage of relevant drug research in children and to relative disinterest on the part of private sector sponsors, who generally have seen little potential for profit in the introduction of therapies targeting children. Exceptions to this pattern are found in drug categories such as anti-infectives, vitamins, respiratory drugs, seizure treatments, and analgesics. Additionally, there has been heavy emphasis placed on the study of drugs affecting behavior in conditions such as attention deficit disorder.