Pediatric Dosing Considerations in Ophthalmology

In almost all cases concerned with topically applied ophthalmic drugs, no distinction is made between adults and infants or children with regard to the concentration and amount of drug used. Even though maximal therapeutic effects are usually observed, there can be significant short- and long-term toxicity problems. Based on some modest assumptions it should be possible to reduce doses without sacrificing therapeutic effectiveness in infants and children up to three years of age. The overriding concern should be, however, potential toxicity problems which may exist in infants and children, in particular the neonate, due to their low body weight and the fact that in most cases, more than 90 percent of an instilled dose in potentially available to act systemically. Total body surface area can be used as a measure for determining potentially toxic doses in children. Especially for potent drugs, with both short- and long-term manifestations, toxicity considerations may necessitate some sacrifice in therapeutic effectiveness of a given drug or switching to an alternate drug in order to insure a reduction in toxic side effects.