Malnourished children have high incidence of intercurrent infections causing frequent use of drugs.The nutritional status is known to alter the biological functions in children. It is essential to know about the pharmacokinetics of drugs for malnourished children in order to ensure the rational use of drugs.
Due to frequent association of hypoproteinemia, the levels of free drugs are likely to be higher in children with PEM. In addition, clearance of drugs by kidneys and their biotransformation by liver may be decreased .Calculation of drug dosage on the basis of body weight may be erroneous because they are likely to have relatively large surface area per unit body mass. It is advisable to calculate drug dosage on the basis of body surface area in malnourished children.
The biological functions recover in a period of 4-6 weeks following nutritional rehabilitation. Therefore, drug administration should be revised when the children has recovered .Saanth of the information is available regarding the pharmacokinetics of drugs in malnutrition but some drugs need special consideration when used in children with PEM.
Malnourished children should not be digitalized as they are sensitive to digitalis and it’s derivatives. Instead, a diuretic should be used alone while treating a congestive heart failure. Due to decreased biotransformation in the liver, glucuronide and sulfate pathways get saturated at lower plasma concentrations of paracetamol thus poisoning, an increased risk of toxicity.
The absorption of Chloramphenicol is not altered by the nutritional stays, but there is a slower rate of its biotransformation by the liver . Accordingly, children with severe PEM should receive two-thirds of the recommended dose of chloramphenicol.
Bioavailability of intramuscular Penicillin is not altered, except in children with gross edema. It appears that in kwashiorkor the renal clearance of penicillin is decreased and it should be administered at longer intervals.
Chloroquine is bound to plasma protein to a greater extent in children with kwashiorkor than in nirmal children and, therefore, reduced amount of free drug is available. Nevertheless, modification in the dosages of chloroquine is not required because of its slower biotransformation in patients with kwashiorkor.
Oral Medications in Children
Most of the medicines are given orally and most children hate to take medicines because of their unpleasant taste. Medicines are absorbed better when given on empty stomach or in-between the meals but they are preferably administered after or along meals to reduce gastric side effects and improve their tolerance.
Drop formulations are preferred in young infants due to small volume of the medicine to be administered. In preschool children, syrup or suspension formulation is usually given. Dispersible tablets or mouth dissolving tablets can be given to children above 2-3 years of age. Most school going children should be able to swallow tablets or capsules but at times even an adolescent child may refuse tot ake a tablet. Some children are extremely prone to vomit when a medicine is given to them.
Medicine should not be poured on the dorsum of tongue but instead between the side of the tongue and cheeks. No medicine should be mixed with the milk or food because the child may stop taking the milk or food after this procedure. The medicine or crushed tablet can be mixed in honey or fruit juice.
The toddlers create a fuss in taking medicines and need to be handled with understanding and firmness. The attention is diverted and child is held firmly while giving the medicine.The older children should be dealt with understanding and explanation that the medicine will make him feel better and he will be able to get better.
