Oral penicillin prescribing for children in the UK: a comparison with<i>BNF for Children</i>age-band recommendations

Saxena, Sonia; Ismael, Zareen; Murray, Macey L; Barker, Charlotte I. S.; Wong, Ian C. K.; Long, Paul F.

doi:10.3399/bjgp14x677842

Cited by 13 publications

(12 citation statements)

References 20 publications

(22 reference statements)

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“…Recent observational studies have also identified that suboptimal dosing of antibacterial and antiviral drugs in children is similarly prevalent. Saxena et al (26), reporting prescribing surveillance data from the United Kingdom, identified that children and adolescents prescribed oral penicillin received doses below the national recommendations in 40% and 70% of cases, respectively. Menson et al (27) described the widespread suboptimal dosing of antiretroviral drugs in children and identified several potential causes of error, including the inadequacy of pharmacokineticpharmacodynamic (PK-PD) data.…”

Section: Discussionmentioning

confidence: 99%

Systemic Antifungal Prescribing in Neonates and Children: Outcomes from the Antibiotic Resistance and Prescribing in European Children (ARPEC) Study

Lestner

Versporten

Doerholt

et al. 2015

Antimicrob Agents Chemother

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The appropriate use of systemic antifungals is vital in the prevention and treatment of invasive fungal infection (IFI) in immunosuppressed children and neonates. This multicenter observational study describes the inpatient prescribing practice of antifungal drugs for children and neonates and identifies factors associated with prescribing variability. A single-day point prevalence study of antimicrobial use in hospitalized neonates and children was performed between October and December 2012. The data were entered through a study-specific Web-based portal using a standardized data entry protocol.

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Section: Discussionmentioning

confidence: 99%

Systemic Antifungal Prescribing in Neonates and Children: Outcomes from the Antibiotic Resistance and Prescribing in European Children (ARPEC) Study

Lestner

Versporten

Doerholt

et al. 2015

Antimicrob Agents Chemother

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“…At present, the doses given for penicillin V and flucloxacillin are exactly the same in the UK, although flucloxacillin was licensed many years later. The dosing regimens for amoxicillin were also originally the same as penicillin V until the dose was recently doubled in older children after we demonstrated a mismatch in prescribing against the guidance 12. In a follow-up paper we modelled this phenomenon and found very little likelihood now of significant underdosing 13.…”

Section: The Impact Of the Early Penicillin V Dosing Regimens On Othementioning

confidence: 99%

Early origins of oral penicillin dosing for children

et al. 2019

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“…In original discussions, it was decided to compare the doses of 125 mg and 250 mg, both three times per day (although the final trial design was based on weight-band dependent dosing). At that time, and in the absence of any randomised evidence, the British National Formulary specified a 250 mg dose, but surveys had shown that the 125 mg dose was more commonly used in clinical practice [ 6 , 7 ]. This raised the dilemma of which dose should be defined as standard and which as experimental.…”

Section: Non-inferiority or Superiority Which Is It?mentioning

confidence: 99%

Superiority and non-inferiority: two sides of the same coin?

Dunn

Copas

Brocklehurst

2018

Trials

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BackgroundThe classification of phase 3 trials as superiority or non-inferiority has become routine, and it is widely accepted that there are important differences between the two types of trial in their design, analysis and interpretation.Main textThere is a clear rationale for the superiority/non-inferiority framework in the context of regulatory trials. The focus of our article is non-regulatory trials with a public health objective. First, using two examples from infectious disease research, we show that the classification of superiority or non-inferiority trials is not always straightforward. Second, we show that several arguments for different approaches to the design, analysis and interpretation of superiority and non-inferiority trials are unconvincing when examined in detail. We consider, in particular, the calculation of sample size (and the choice of delta or the non-inferiority margin), intention-to-treat versus per-protocol analyses, and one-sided versus two-sided confidence intervals. We argue that the superiority/non-inferiority framework is not just unnecessary but can have a detrimental effect, being a barrier to clear scientific thought and communication. In particular, it places undue emphasis on tests for significance or non-inferiority at the expense of estimation. We emphasise that these concerns apply to phase 3 non-regulatory trials in general, not just to those where the classification of the trial as superiority or non-inferiority is ambiguous.ConclusionsGuidelines and statistical practice should abandon the sharp division between superiority and non-inferiority phase 3 non-regulatory trials and be more closely aligned to the clinical and public health questions that motivate the trial.

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Oral penicillin prescribing for children in the UK: a comparison withBNF for Childrenage-band recommendations

Abstract: BackgroundThe British National Formulary for Children (BNFC) recommends dosing oral penicillins according to age-bands, weight-bands, or weight-based calculations. Because of the rising prevalence of childhood obesity, age-band-based prescribing could lead to subtherapeutic dosing.

Cited by 13 publications

References 20 publications

Systemic Antifungal Prescribing in Neonates and Children: Outcomes from the Antibiotic Resistance and Prescribing in European Children (ARPEC) Study

Systemic Antifungal Prescribing in Neonates and Children: Outcomes from the Antibiotic Resistance and Prescribing in European Children (ARPEC) Study

Early origins of oral penicillin dosing for children

Superiority and non-inferiority: two sides of the same coin?

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