- A Word from the Guest Editor
In the pediatric population, acute respiratory tract infections (RTIs, comprising the common cold, sinusitis, pharyngitis, otitis media, laryngotracheitis, bronchitis/bronchiolitis, and pneumonia) are the most common reason for seeking professional help from a physician or a pharmacist. Although most RTIs are caused by viruses and have a self-limiting character, antibiotics are often prescribed. Unjustified use of antibiotics can lead to adverse drug reactions, spread of antimicrobial resistance and increased treatment costs; it is thus extremely important to use them rationally. In their article, Basa and Sovtić provide a short overview of the clinical presentation and diagnostics of common RTIs in children and a detailed review of current clinical guidelines for their treatment, paying special attention to the criteria for introducing antibiotics.
Common local symptoms of RTIs are nasal congestion with rhinorrhea, sore throat, and cough, and if present, systemic symptoms are usually a fever and headache. Tomić and Pecikoza review non-pharmacological measures (e.g. oral hydration, nasal saline application or irrigation, honey) and medications (nasal decongestants, cough suppressants, mucolytics, expectorants, antipyretics/analgesics and sore throat local preparations) used for RTI symptom mitigation. The current clinical evidence on the efficacy and safety of these treatments in the pediatric age group is discussed, and an overview of the available medications with pharmaceutical forms and dose regimens for the appropriate age is also given.
Kundaković and Maksimović focus on herbal medicinal products for relieving RTI symptoms in children: expectorants (e.g. Hederae helicis folium extract), demulcents (e.g. Althaeae radix, Plantaginis lanceolatae folium) and extracts for the alleviation of nasal symptoms and sore throat (e.g. Sisymbrii officinalis herba, Pelargonii radix). The available efficacy and safety data are considered. A comprehensive overview of the European Union herbal monographs and their suitability for use in children is displayed.
Specific pharmacokinetics of medicines in the pediatric population, and consequently different dosing than in adults, are considered in the article of Jovanović and Vučićević. The main sources of pharmacokinetic variability (changes in drug absorption, distribution, and elimination) are liver and kidney development, as well as differences in body composition (e.g., water and adipose tissue content) at different ages. Pharmacokinetic characteristics of certain antibiotics in children are also considered.
Facts and tips concerning the selection of an appropriate drug dosage form for the treatment of RTIs in children are presented by Cvijić et al. The choice mostly depends on the characteristics of the drug, age and general condition of a patient. Preparations for oral, parenteral and inhalation administration are mostly used. However, many drugs are not available in the appropriate pharmaceutical form and/or strength for children, which is why their unauthorized use is common. When choosing/making preparations for children, it is necessary to carefully consider the composition of the preparation (safety of excipients), and to adjust the choice of applicator to the child’s age.
It is my honor and pleasure to have the opportunity to edit this thematic issue of the Archives of Pharmacy. I believe that its contents will provide valuable information for healthcare professionals in their everyday practice.
Prof. Maja Tomić, PhD
University of Belgrade – Faculty of Pharmacy
Department of Pharmacology