Comparative study of rules employed for calculation of pediatric drug dosage

Elias, Gracieli Prado; Antoniali, Cristina; Mariano, Ronaldo Célio

doi:10.1590/s1678-77572005000200004

Cited by 14 publications

(12 citation statements)

References 5 publications

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“…A study carried out by Elias GP et al, showed that standard doses calculated by Clark's formula for amoxicillin and erythromycin was not statistically significant (p>0.05) in three groups of children, group 1: age 1-3 years, group 2: age 3-5 years and group 3: age 6-12 years. 21 This finding is similar to our study. In a study by Lesar TS et al, showed that errors most commonly involved children (69.5%) and that too because of antibiotics (53.5%).…”

Section: Discussionsupporting

confidence: 93%

“…The many calculations required in paediatrics to do weight based dosing may be an important factor contributing to the high rates of prescribing errors There was lack of published studies on dose calculation of different antihistaminic drugs in paediatric patients. In our study there was statistical significant difference in prescribed and standard doses of paracetamol which was similar to the study carried out by Elias GP et al 21 They calculated standard dose of paracetamol with the formula based on body surface area and found out it was statistically significantly different than the prescribed dose. It was much closer to the hepatotoxic dose of paracetamol for children.…”

Section: Discussionsupporting

confidence: 89%

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An analysis of ear discharge and antimicrobial sensitivity to the bacteria used in its treatment

2016

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Background: Children are unique population with distinct development and physiological differences from adults, clinical trials in children are essential to develop age-specific, empiricallyverified therapies and interventions to determine and improve the best medical treatment available. The aim of this study was to find out the appropriateness and accuracy of the dose of drugs prescribed and compares it with standard dose. Methods: Total 400 prescriptions were collected from the OPD of the paediatrics of Shree Krishna Hospital, Karamsad. Calculation of standard total daily dose for each drug was done by using Clark's formula and was compared with that of prescribed dose of that particular drug. Results: Total 1042 drugs were prescribed. Among antibiotics (22%) statistically significant difference in the prescribed and standard total daily dose was observed with cefexime [t-value 28.6>1.96 for 95% confidence interval] and metronidazole [t-value2.03>1.96 for 95% confidence interval], NSAIDs (31%), Paracetamol [t-value11.14>1.96 for 95% confidence interval] and antihistaminics (22%), phenylephrine [t-value7.1>1.96 for 95% confidence interval], cetrizine [t-value2.4>2.00 for 95% confidence interval]. Conclusions: Results show that prescribed doses of commonly used drugs were higher than the standard dose. This is directly related to the occurrence and severity of adverse drug reactions.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 89%

An analysis of ear discharge and antimicrobial sensitivity to the bacteria used in its treatment

2016

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“…Dosages based on the body weight are believed to be insufficient for the achievement of proper serum concentration of most drugs, the body surface being the most valid basis for dosage, since it is related to some physiological functions that account for the differences in pharmacokinetics in patients of different ages. 4 The British National Formulary (BNF), Martindale's Pharmacopoeia and many other reference textbooks state that the most reliable methods for calculation of children's drug doses are those based on BSA. 5 The average number of drugs per prescription 2.92 in our study has been similar to the reported figure of 2.9 in another study conducted in Mumbai.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

IJPSR

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Background: Pediatrics pose a unique set of risks of medication errors, predominantly because of the need to make dosage calculations, which are individually based on the patient's weight, age or body surface area (BSA), and their condition. This increases the likelihood of errors, particularly dosing errors. In particular; preventing dosing errors is an important part of ensuring safe and quality patient care in the pediatric population. To evaluate appropriateness and accuracy of the prescribed drug dose using BSA as a parameter in pediatric patients. Methods: The present study was cross sectional, observational, and prospective one, conducted on an outpatient basis in pediatric patients. A total of 500 prescriptions were randomly collected and used to analyze prescribed dose. Calculation of standard dose according to BSA of individual of each drug was done by using formula: Individual dose = BSA (m 2 )/1.7 × average adult dose and compared with the prescribed dose of that particular drug. The BSA of an individual can be calculated from Dubois Raymond's formula. Results: The 500 prescriptions included in the study were for a total of 1216 drugs; out of which 362 (29.76%) drugs were in under dose, 245 (20.15%) drugs were in appropriate dose and 609 (50.08%) drugs were in overdose compared to their standard doses according to BSA. Conclusion: In this study, around 80% of prescribed drugs were either under dose or overdose which highlights the continuing crisis of dose calculation error among prescriptions of pediatric patients.

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“…In this study, we used a FDA-predicted dose model for warfarin, at first, and thereafter adjusted the recommended dose in each child, based on the body surface area. Clarcks, Salisbary, and Pennas formulations ( 31 ) showed a moderate association between the predicted warfarin dose, based on genotyping, and the stable anticoagulation dose (r = 0.5, P <0.001). The other studies have demonstrated similar results in their studies ( 18 , 21 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…Sensitivity to warfarin and recommended dose, based on the genotyping results, were reported by genetic laboratory, considering the international warfarin pharmacogenetics consortium algorithms ( Tables 1 and 2 ) ( 30 ). Thereafter, the required dose of warfarin in each pediatric patient was determined, considering the dose recommended by genotyping and adjusted according to the patient’s height, weight, and body surface area, using the Pennas, Salisbary, and Clarks formula ( 31 ).…”

Section: Methodsmentioning

confidence: 99%

Enzyme polymorphism in warfarin dose management after pediatric cardiac surgery

Tabib¹,

Najibi²,

Dalili³

et al. 2015

Res Cardiovasc Med

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Background:Warfarin is an anticoagulant and is widely used for the prevention of thromboembolic events. Genetic variants of the enzymes that metabolize warfarin, i.e. cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKORC1), contribute to differences in patients’ responses to various warfarin doses. There is, however, a dearth of data on the role of these variants during initial anticoagulation in pediatric patients.Objectives:We aimed to evaluate the role of genetic variants of warfarin metabolizing enzymes in anticoagulation in a pediatric population.Patients and Methods:In this prospective cohort study, 200 pediatric patients, who required warfarin therapy after cardiac surgery, were enrolled and divided into two groups. For 50 cases, warfarin was prescribed based on their genotyping (group 1) and for the remaining 150 cases, warfarin was prescribed based on our institute routine warfarin dosing (group 2). The study endpoints were comprised of time to reach the first therapeutic international normalization ratio (INR), time to reach a stable warfarin maintenance dose, time with over-anticoagulation, bleeding episodes, hospital stay days and stable warfarin maintenance dose.Results:There was no significant difference concerning the demographic data between the two groups. The time to stable warfarin maintenance dose and hospital stay days were significantly lower in group 1 (P <0.001). However, there was no statistically significant difference in time to reach the first therapeutic INR, time with over-anticoagulation and bleeding episodes, between the two groups.Conclusions:The determination of warfarin dose, based on genotyping, might reduce the time to achieve stable anticoagulation of warfarin dose and length of hospital stay.

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Comparative study of rules employed for calculation of pediatric drug dosage

Cited by 14 publications

References 5 publications

An analysis of ear discharge and antimicrobial sensitivity to the bacteria used in its treatment

An analysis of ear discharge and antimicrobial sensitivity to the bacteria used in its treatment

Untitled

Enzyme polymorphism in warfarin dose management after pediatric cardiac surgery

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