Liquid Drug Dosage Measurement Errors with Different Dosing Devices

Joshi, Pradnya; Bavdekar, Sandeep B

doi:10.1007/s12098-019-02894-8

Cited by 17 publications

(14 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, to perform the measurement, it The mean values measured with the oral syringe (3.3 (±0.1) g for 2.5 mL and 6.5 (±0.2) g for 5 mL) are significantly higher than the reference value (2.5 mL = 3.18 (±0.01) g and 5 mL = 6.31 (±0.03) g) resulting in an overdose. However, previous studies have reported the use of oral syringes associated with greater accurate measurements [6,10,18]. This measurement error can be explained by the fact that the oral syringe does not have an adapter for the amber vial of the antibiotic.…”

Section: Discussionmentioning

confidence: 98%

“…However, during the utilization of the double-dosing spoon and the transparent spoon, volunteers clearly preferred the design and characteristics of the transparent dosing spoon. Previous works also assessed user preferences ranging from dosing spoon [9,10], oral syringe [6] to dosing cup [18]. These facts make it possible to speculate that any device available with the medicine will allow for identical doses.…”

Section: Discussionmentioning

confidence: 99%

“…Some works have been reported on the accuracy of administration devices [6,9,10,18], but none discuss the importance of the design of a given type of device neither the risk of misuse of reconstitution devices as administration devices. The compliance of shaking suspensions before use was assessed through a cross-sectional questionnaire applied to mothers but not experimentally evaluated [6].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dosing Accuracy of Oral Extemporaneous Suspensions of Antibiotics: Measuring Procedures and Administration Devices

Neves

Auxtero

2021

Pharmaceutics

View full text Add to dashboard Cite

Extemporaneous suspensions are often marketed with several administration devices that can be freely used by patients/caregivers. The homogeneity of suspensions requires shaking before use. Hence, it is crucial to assess the precision of all devices and the users’ awareness of the shaking procedure. This study was conducted at University Institute Egas Moniz with 40 pharmacy students who were asked to measure 2.5 and 5 mL of two extemporaneous azithromycin suspensions. Formulation A is marketed with a double-dosing spoon and oral syringe, whereas B includes a transparent dosing spoon. Both have a reconstitution cup. The user’s preference for administration devices, the degree of compliance with the ‘shake before use’ instruction and the accuracy of the manipulation were assessed. The double-dosing spoon was the preferred device. The “shake before use” instruction was overlooked by most volunteers. The average measured volumes obtained with the double-dosing spoon were significantly different from the ones obtained with the oral syringe (p < 0.001) and significantly lower than the reference dose (p < 0.001). The oral syringe originates significantly higher values than the reference dose (p < 0.001). The dosing spoons values were significantly different from each other (p < 0.001). Liquid medicines containing several administration devices may be a challenge since they are nonequivalent.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dosing Accuracy of Oral Extemporaneous Suspensions of Antibiotics: Measuring Procedures and Administration Devices

Neves

Auxtero

2021

Pharmaceutics

View full text Add to dashboard Cite

show abstract

“…More recently, following dosing accuracy studies of over the counter products, the FDA has set stricter guidelines for dosing accuracy, while the EMA has provided reflections on typical oral dose volumes for different age groups [19], and subsequently general guidance on appropriate measuring devices for oral liquids [12]. These requirements effectively stop the use of dosing cups for volumes below 5 mL since evidence from studies suggests that it is somewhat difficult to dose small volumes correctly with cups, and to a lesser extent, with spoons [10,18,20]. Therefore, appropriately graduated oral dosing syringes are currently the preferred device for small volumes, although the situation may not be optimal yet [9].…”

Section: Pharma Industry Perspectivesmentioning

confidence: 99%

European Paediatric Formulation Initiative workshop report: Improving the administration of oral liquid medicines in paediatrics using dosing syringes and enteral accessories

Walsh¹,

Riet–Nales

Hermans

et al. 2020

European Journal of Pharmaceutics and Biopharmaceutics

View full text Add to dashboard Cite

Rutger de Vries & Diana van Riet-Nales are members of the European Medicines Agency (EMA) Paediatric Committee (PDCO) Formulation Working Group (FWG). Diana van Riet-Nales is also member of the EMA Quality Working Party and the Dutch Medicines Evaluation Board (MEB) Committee on Clinical Practice.Diana van Riet-Nales was rapporteur for the EMA Guideline on pharmaceutical development of medicines for paediatric use, the reflection paper on the pharmaceutical development of medicines for use in the older population and the EMA Q&A on small volumes. She was a drafting group member of the Q&A on enteral feeding and the EMA guideline on drug device combination products. Rutger de Vries supported the work on the paediatric guideline. He was a member of the drafting group on the EMA Q&A for small volumes and enteral feeding.

show abstract

“…Liquid preparations are more vulnerable for dosing errors as they are more susceptible to dosage errors associated with the dosing device [ 9 ]. Many caregivers, including those in low- and middle-income countries (LMICs), commonly use substandard household items such as teaspoons and tablespoons or cups for measuring and administering liquid medications instead of standard liquid medication delivery devices such as medicine cups, droppers, calibrated spoons, and syringes [ 6 , 9 , 13 ]. These standard delivery devices may be lost by parents at home or become dirty, especially in LMICs.…”

Section: Introductionmentioning

confidence: 99%

Can use of pictograms reduce liquid medication administration errors by mothers? An interventional study

2021

View full text Add to dashboard Cite

Background Liquid medication dosing errors (LMDE) made by caregivers affect treatment in children, but this is not a well-studied topic in many low-and middle-income countries including in India. Methods An intervention study was conducted among mothers attending a pediatric outpatient clinic of a tertiary care setting in Ujjain, India. The mothers randomly measured 12 volumes of a paracetamol liquid preparation by using a dropper (0.5 and 1 mL), measuring cup (2.5 and 5 mL), and calibrated spoon (2.5 and 5 mL) each with two instructions—oral-only measurement session (OMS) and oral plus pictogram measurement session (OPMS, the intervention). The main outcome was dosing error prevalence. The effectiveness of the intervention was assessed by measuring effect size. Risk factors for maximum LMDE were explored using backward multivariate logistic regression models. A P value of < 0.05 was considered statistically significant. Results In total, 310 mothers [mean (± SD) age, 30.2 (± 4.18) years] were included. LMDE prevalence in the OMS versus OPMS for dropper 0.5 mL was 60% versus 48%; for l mL dropper was 63% versus 54%; for 2.5 mL cup 62% versus 54%; for 2.5 calibrated spoon 66% versus 59%; 5 mL cup 69% versus 57%; and 5 mL calibrated spoon 68% versus 55%. Comparing OMS with OPMS, underdosing was minimum with the calibrated spoon for 2.5 mL (OR 4.39) and maximum with the dropper for 1 mL (OR 9.40), and overdosing was minimum with the dropper for 0.5 mL (OR 7.12) and maximum with the calibrated spoon for 2.5 mL (OR 13.24). The effect size (dCohen) of the intervention OPMS was 1.86–6.4. Risk factors for the most prevalent dosing error, that is, with the calibrated spoon for 2.5 mL, were increasing age of the mother (aOR 1.08; P = 0.026) and nuclear family (aOR 2.83; P = 0.002). The risk of dosing errors decreased with higher education of the mothers. Conclusions Pictograms can effectively minimize LMDE even in less educated mothers.

show abstract

Liquid Drug Dosage Measurement Errors with Different Dosing Devices

Cited by 17 publications

References 10 publications

Dosing Accuracy of Oral Extemporaneous Suspensions of Antibiotics: Measuring Procedures and Administration Devices

Dosing Accuracy of Oral Extemporaneous Suspensions of Antibiotics: Measuring Procedures and Administration Devices

European Paediatric Formulation Initiative workshop report: Improving the administration of oral liquid medicines in paediatrics using dosing syringes and enteral accessories

Can use of pictograms reduce liquid medication administration errors by mothers? An interventional study

Contact Info

Product

Resources

About