11 Sep, 14 | by Bob Phillips
How can we determine the safety if anything we do in paediatric prescribing? For chronic conditions, we’re generally pretty sure that if we let it wind on, it will harm the child. If we treat it, we’ll be managing the disease but causing adversity. The balance is making this tip where the good stuff overwhelms the poor stuff.
I think the commonest, extreme, example is chemotherapy. These agents are intended to treat a cancer to save a life. To do this, they may cause sufficient immunosupression to produce a fatal infection, or mucosal erosions to give a fatal intestinal perforation, or a thrombotic event that produces a cerebral infarct and death. The carefully measured doses of these drugs are placed to make the tipping point in favour of benefit over harm; and we have improved survival in childhood cancer by this treatment approach.