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1. Uso Eficaz de Medicamentos en
Atencion Primaria Infantil
Dr Heraldo Povea Pacci
MD (Chile) MSc (Gran Bretaña) Fellow (EEUU) PhD (Australia)
Miembro Comité Inmunizaciones Ministerio Salud Chile
Academico U. Diego Portales Chile
Especialista en Inmunologia y Salud Sexual
Consultor en Educacion Superior

2. Plan de la Presentacion:
 El manejo actual de la medicacion en la
salud en niños
 Respuestas globales: Accion de la OMS.
 La dosificacion como uno de los
principales factores problematicos
 Medicamentos y lactancia materna
 Conclusiones

3. Report of the
Third Partners' Meeting on
Better Medicines for Children
World Health Organization
Geneva, Switzerland
21-22 November 2011

4. Progress:
1) The development of global norms
and standards
• The third edition of the WHO Model List of Essential
Medicines for Children1 was published following the
Expert Committee Meeting on the Selection and Use
of Medicines that met in March 2011. The list is a
valuable tool for countries in developing their own
national Essential Medicines Lists.
• The list of Priority Medicines for Children2 was launched
this year highlighting those medicines with the
greatest impact on child mortality.

5. Progress
2) Working with all WHO programs to
ensure that they contribute to making
safe and effective medicines available
 Examples of departmental collaborations in WHO are with
Essential Medicines and
 Pharmaceutical Policies, Stop TB, Global Drug Facility, HIV, Roll
Back Malaria and Child and Adolescent Health.

6. Progress:
 3) Promotion of norms and standards for
quality and safety of children‘ medicines
and regulatory capacity
 Guidance document on assessing clinical trials in children1 has
been published to help clinical trial assessors and their agencies
improve their capacity to assess trials in paediatric populations.
 The Paediatric medicines Regulators Network (PmRN)2
comprising 30 members was established as a forum to discuss and
raise awareness of paediatric medicines.
 Publication of regulatory documents.

7. Progress:
4) To make available treatment guidelines
and medicines information
 WHO recommendations on the management of diarrhoea
and pneumonia in HIV‐infected infants and children has
been published4.
 The new edition of the Pocketbook for Hospital Care
for Children5 will be launched shortly.
 WHO Guidelines on Pharmacological Treatment of
Persisting Pain in Children with Medical Illnesses is in press.

8. Progress:
 5) Collaborating to encourage fair trade
and adequate financing for medicines for
children
 An informal working group on market shaping for priority
medicines for children has been established which will contribute
to the new UN Commission on overlooked commodities, that will
begin work in 2012.
 Pricing guidelines for paediatric products are under development.

9. Why are Medications Given at All?
 Prevent illness: Barrier cream to prevent
diaper rash
 Relieve symptoms: Fever reducing
medications
 Control or cure health problems:
◦ Short term: Antifungal cream to treat a fungal
diaper rash
◦ Emergency: Albuterol for wheezing
◦ Long term: Anti-seizure medications

10. Responsibility Triangle
Parent/Guardian
Child
Child Care Health Care
Provider Professional

11. Parent or Guardian Responsibilities
 Regular checkups and up-to-date immunizations
 Complete communication about child’s symptoms and
health status
 Consulting with their child’s health care professional
about diagnosis and care
 Compliance with medication policies and completion of
forms
 Communication with health care professionals about
the child care setting (environment, capabilities of staff,
hours that the child attends)

12. Parent/Guardian Responsibilities,
continued
 Asking the health care professional about whether medication can be
given at home and NOT in child care
 Providing properly labeled medication and providing appropriate
measuring devices
 Providing up-to-date emergency contact phone numbers
 Promptly picking up their child when notified of illness
 Arranging for back-up care
 Working constructively with child care providers to determine when it
is appropriate to care for their child during mild illness

13. Health Care Professional
Responsibilities
 Complete all child care health forms legibly
 Discuss medication needs with parent or guardian and if
needed, with child care providers, if parental permission is
obtained
 Adapt medication schedules to meet the needs of children in
child care and limit the number of doses that need to be
given in child care
 Provide guidance and education as requested
 Promote disease prevention and good health practices
 Be accessible to child care staff for questions and concerns
about their patients, with parental permission

14. Child Care Health Consultant
 A trained health care professional who provides
consultation and technical assistance on health
issues in child care
 Child care facilities can request consultation
from professionals with special expertise

15. Types of Medication
 Prescription (Rx), over-the-counter
(OTC), and
non-traditional
 Brand name and generic
 Oral, topical, and inhaled, etc

16. Prescription Medication
 Can only be prescribed by an authorized
health care professional
 Are dispensed by a pharmacist
 Are considered “controlled substances” if
they can be dangerous or addictive
◦ Controlled substances have special rules
 “Sample” medication must be properly
labeled

17. OTC (over the counter) Medication
 Can be purchased without a prescription
 Vitamins
 Homeopathic medication
 Herbal medication
 Sun screen, insect repellant, and non-
medicated diaper cream often have
different regulations
◦ Check your state regulations

18. Common OTC Medication
 Fever reducer or pain reliever
 Antihistamines
 Mild cortisone cream
 Cough syrups and cold remedies
 Nose drops
 Medications used for common gastrointestinal problems
 Many OTC medications do not have dosing information for
children under the age of 24 months

19. Brand Name and Generic
Medications
 Both prescription and OTC medications come as
◦ Brand name
◦ Generic
 This creates an opportunity for mistakes and confusion
◦ Names that are difficult to remember and to say
◦ Available under several names
◦ Sound alike names
 Zantac (reduces stomach acid) and Zyrtec (antihistamine)
® ®
 Bacitracin® (antibiotic cream) and Bactrim® (oral antibiotic)

20. Problemas con la administracion de
medicamentos en niños:
 Efectos adversos
 Errores en la dispensacion
 Efectos adversos causados por un error
en la dispensacion

21. Situacion actual:
 Alza en la frecuencia de errores resultando en muerte
o daño en niños en comparacion con adultos:
 (US Pharmacopeia (USP) Medication Errors Reporting Program 1995-99)
 Pacientes pediatricos: (31%),
 Pacientes adultos:(13%).
 Recientemente, Efectos adversos ocurrieron en la
misma frecuencia en niños y adultos: (5.7%) y (5.3%).
 Pero, afectos adversos potencialmente errores fueron 3
veces mas frecuentes en niños.

22. Causa mas frecuente de errores:
 Dosificacion:
Pacientes pediatricos: 47%
Pacientes adultos: 25%
 Quinta causa mas comun de problemas
legales en pediatras en EEUU.

23. Dosificacion:
 Niños varian en peso, superficie corporal y
maduracion de sistemas organicos.
 Afecta su capacidad de metabolizar y excretar
medicamentos.
 Hay muy pocos esquemas standarizados y
generalmente se requiere calcular dosis sobre
base de peso corporal.

24. Manejo
 Causas multifactoriales
Requiere manejo como equipo de salud
con mejoria de comunicacion y de
sistemas de trabajo.

25. Causas de errores de dosificacion en
EEUU (2000)
 Mal Procedimiento
 Procedimiento mal efectuado
 Error de comunicación
 Error en la transcripcion
 Documentacion mal efectuada
 Error en Distribucion del medicamento
 Ignorancia del profesional de la salud
 Error de calculo
 Error de digitacion en computador
 Falla de sistemas de alarmas.

26. Recomendaciones generales
 Calculo de peso preciso
 Situacion emocional del paciente y la
familia.
 Situacion de desarrollo y madurez del
niño.
 Comunicacion eficaz
 Compromiso del paciente y la familia
durante el proceso.

27. Recomendaciones al personal de
enfermeria
 * Chequear calculos de dosificacion con otro
miembro del equipo de salud.
 * Confirmar identificacion del paciente antes de
cada dosis.
 Familiaridad con el sistema de prescripcion y
dispensacion.

28. Recomendaciones al personal de
enfermeria
 Verificar prescripcion antes de la
administracion.
 Confirmar dosis poco habituales.
 Comunicarse efectivamente con el paciente o la
familia y contrachequear prescripcion y
dosificacion.
 Permanecer familiarizado con los equipos de
dispensacion y dosificacion.

29. Uso de medicamentos durante la
lactancia materna
 Muchos medicamentos entran en la leche
materna, pero generalmente lo que el lactante
recibe es menos del 10% de la dosis materna.
 Es util recordar que el feto recibe 5 a 10 veces
mas del medicamento administrado a la madre
que el lactante.

30. Principales puntos a recordar
 La mayoria de los medicamentos son
seguros para usar en madres lactando.
 Si un medicamento es seguro para un
lactante, sera generalmente seguro para
madres amamantando.

31. Principales puntos a recordar
 Solo un pequeño numero de medicamentos
estan contraindicados durante la lactancia.
 Es necesario evaluar los riesgos y beneficios de
cada medicamento para la madre y el lactante.
 Siempre elegir medicamentos con vida media
corta, alta afinidad por proteinas, baja
biodisponibilidad oral o alto peso molecular.

32. Principales puntos a recordar
 La edad y peso del lactante deben ser
considerados.
 Usar medicamentos topicos o locales cuando
sea posible (gotas oftalmicas, inhaladores).
 Medicamentos usados en los primeros 3-4 dias
postpartum determinan generalmente niveles
sub.clinicos en el lactante, debido a la poca
cantidad de leche materna.

33. Conclusiones:
 La medicacion y administracion de
medicamentos en salud infantil requiere una
mayor atencion del equipo de salud y de los
organismos sanitarios.
 Existe una relativa carencia de conocimientos
rigurosos para la medicacion en niños
 Existen pocas guias para el manejo de
medicamentos

34. Conclusiones:
 El manejo eficaz y seguro de medicamentos en
niños requiere de una colaboracion
interdisciplinaria y la participacion de padres y
profesionales a cargo de niños.
 Dosificacion es un gran problema y requiere un
manejo riguroso.
 Medicacion en la mujer lactante debe incluirse
en este capitulo de la accion sanitaria.