Routes of Administration and Drug Formulations

Depending on age, disease, and disease severity, different routes of administration may be considered. Use of rectal route of administration is reserved in cases where oral administration is not possible and IV route is not necessary. Topical administration is often used for treatment of dermatologic ailments. Transdermal routes are often not recommended, unless it is an approved indication such as the methylphenidate transdermal patch for treatment of attention deficit hyperactivity disorder. The injectable route of administration is used in patients with severe illnesses or when other routes of administration are not possible. As done with adult patients, IV compatibility and access should be evaluated when giving parenteral medications. However, dilution of parenteral medications may be necessary to measure smaller doses for neonates. On the other hand, higher concentration of parenteral medications may be necessary for patients with fluid restrictions such as premature infants, and patients with cardiac anomalies and/or renal disease. Appropriate stability and diluent selection data should be obtained from the literature.

When oral drug therapy is needed, one must also consider the type of dosage form available. Children less than 6 years of age are often not able to swallow oral tablets or capsules and may require oral liquid formulations. The child's ability to swallow a solid dosage form should be determined before selecting a drug product. Not all oral medications, especially those unapproved for use in infants and children, have a commercially available liquid dosage form. Use of a liquid formulation compounded from a solid oral dosage form is an option, when data are available. Factors such as stability, suspendability, dose uniformity, and palatability should be considered when compounding a liquid formulation. Commonly used suspending agents include methylcellulose and carboxymethylcellulose (e.g., Ora-Plus). Palatability of a liquid formulation can be enhanced by using simple syrup or OraSweet. If no dietary contraindications or interactions exist, doses can be mixed with food items such as pud ding, chocolate syrup, or applesauce immediately before administration of individual doses. Honey, although capable of masking unpleasant taste of medication, may contain spores of Clostridium botulinum and should not be given to infants less than 1 year of age due to increased risk for developing illness. Most hospitals caring for pe-diatric patients compound formulations in their inpatient pharmacy. Limited accessibility to compounded oral liquids in community pharmacies poses a greater challenge. A list of community pharmacies with compounding capabilities should be maintained and provided to the parents and caregivers before discharge from the hospital.

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