PEDIATRIC ANTIBIOTIC DOSING
One of the mantras that pediatricians hold dear is that “children are not just small adults”. In other words, you can’t just take a treatment that’s effective for an adult and cut the dose in half to give to a child. The problem is that because of a relative lack of research into the effect of medications in kids, historically children’s doses were often simply estimated based on adult doses.
A new report in the British Medical Journal (BMJ) is calling for a better, consistent approach to dosing children’s medications and particularly for antibiotics. Specifically, the BMJ article raises concerns about the practice of setting out the dosage regimens based on age. Because children of the same age can be vastly different in size, to achieve consistent dosing it is best to use a child’s weight as the basis for the amount of medication to be given. But systematic use of a “milligram per kilogram” approach to prescription is not always used in a clinical setting, where doctors may estimate the appropriate dose for a child’s weight just by looking at them.
In Canada, there are no nationally recognized guidelines for pediatric antibiotic prescription, although Dr. Joan Robinson of the Canadian Pediatric Society thinks it would be a good idea. In my conversation with her she pointed out that because health is under provincial jurisdiction, each province tends to recommend its own guidelines, and they can vary between provinces, medical organizations and institutions.
One of the challenges of creating guidelines for the myriad antibiotics used in children is that often there are insufficient reliability, effectiveness and safety studies available. In the past 10 years the situation improved when the U.S. FDA created financial incentives for pharmaceutical companies to do more research into medications and kids.
There is some concern that the lack of systematic prescribing practices for antibiotics may lead to insufficient doses that can cause antibiotic resistance (i.e. when antibiotics become less effective against bacteria, making them harder to kill). While this is possible, the larger problem that may cause resistance is more likely the over-prescription of antibiotics in inappropriate situations where they are not needed (e.g. for a cold or other viral illness).
You can help to prevent antibiotic resistance by always taking antibiotics exactly as prescribed until they are all gone, and not saving them to be used later.
For detailed information on antibiotic resistance, see: http://www.cdc.gov/getsmart/antibiotic-use/anitbiotic-resistance-faqs.html
(Photo courtesy of the blog “Writing From Scratch”)
- drkarlkabasele posted this