Precision Dosing in Children

Abstract

Unlike adult medicine, there are fewer choices of medicines per condition in children, and for existing medications, supporting data on pharmacokinetics, pharmacodynamics, or pharmacogenomics is often incomplete. Many pediatric doses are calculated using body weight to produce a dose for the individual child, but this is not true personalisation as the dose suggested (usually in mg/kg) is the same for a large age range of children. The challenge for implementation of precision medicine in pediatrics is therefore to develop an appropriate evidence base (particularly for unlicensed and off label medications), then add onto it the relevant genotype, environmental and lifestyle data to guide both medication selection (where choices exist) and the dose required. This review will consider where consideration of dose is crucial in pediatrics, including the developmental changes across childhood, pediatric obesity, and old and new medicines where data on dosing are scarce and/or inadequately extrapolated from adults