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PEDIATRIC PRESCRIBING

PEDIATRIC PRESCRIBING. By Dr. M. RAMESH M. Pharm, PhD, DipClinPharm, FICP (Australia) Professor Department of Pharmacy Practice JSS College of Pharmacy, Mysore. Introduction. Use of medicines in children is a challenge They react differently from adults to drugs

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PEDIATRIC PRESCRIBING

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  1. PEDIATRIC PRESCRIBING By Dr. M. RAMESH M. Pharm, PhD, DipClinPharm, FICP (Australia) Professor Department of Pharmacy Practice JSS College of Pharmacy, Mysore

  2. Introduction Use of medicines in children is a challenge • They react differently from adults to drugs • Pharmacokinetic variation -- Change in body compartments -- Vd is high for neonates and infants -- Protein binding is less in neonates and infants • Lack of clinical trials

  3. Pediatric age group • Neonates -- Birth to 1 month • Infants -- 1 month to 1 year • Children -- 1 year to 12 years • Adolescent -- 12 to 18 years

  4. Prescription writing • Should be written according to prescription writing guidelines • Should state age, dose, frequency, route of administration and duration • Body wt and height should be stated

  5. Prescription writing • Prefer oral route where possible • Should state the strength of cap/tab and concentration of oral liquids • Do not prescribe oral liquids in teaspoon measurement

  6. Prescription writing • Where possible reduce the dosing frequency • Use inhaler aids and spacers for inhaled drugs • Do not mix the drug with food /infants feed

  7. Prescription writing • Advice parents about child’s medication • Advise the parents to keep the medicines out of reach of children

  8. Factors to be considered • Age • Dose • Dosing frequency • Routes of administration

  9. Age • Variable in kinetics Neonates -- Decrease in clearance Infants -- Increase in clearance Children -- Decrease to reach adult rate of clearance • Neonatal skin is highly permeable • IM injection is painful (less muscle mass)

  10. DoseDosing methods • Body surface area (BSA) • Body weight (mg/kg) • Percentage of adult dose (based on age)

  11. Dosing method Body surface area (BSA) More accurate method • BSA (m2) = Ht (cm) X Wt (kg) 3600 or Ht (in) X Wt (lb) 3131 • Child’s dose = BSA 1.73 X Adult dose

  12. Dosing method Body weight (mg/kg) Most commonly approached method i) Augsberger’s rule: Child’s approximate dose = (1.5 X Wt in Kg + 10) % of adult dose

  13. Dosing method Body weight (mg/kg) ii) Clark’s rule: Child’s approximate dose = Wt (in pounds) 150 X Adult dose

  14. Dosing method Ideal body weight (mg/kg) Useful in patients with large variations from ideal body weight Children 1 to 18 years: IBW (kg) = (Ht2 (cm) X 1.65) 1000

  15. Dosing method Ideal body weight (mg/kg) • Children 5 feet and taller Male = 39 + (2.27 X Ht in inches) Female = 42. 2 + (2.27 X Ht in inches) • Use adult dose if -- Dose exceeds adult dose -- Child weighs >40 Kg or >12 years

  16. Percentage of adult dose (based on age) Age % of adult dose New born 12.5 1 month 14.5 3 months 18

  17. Percentage of adult dose (based on age) Age % of adult dose 6 months 22 1 year 25 3 years 33

  18. Percentage of adult dose (based on age) Age % of adult dose 5 years 40 7 years 50 12 years 75

  19. Dose calculation • Never guess or roughly estimate • Consider BSA where possible • Adjust the dose according to body weight

  20. Dose calculation • Individualize the dose • Consider other factors (renal/hepatic status)

  21. Dosing frequency • Reduce the dosing frequency when possible • Consider some flexibility in frequency

  22. Routes of administrationOral • Preferred method unless other specific indication • Liquid preparations are most preferred • In prolonged therapy sugar free preparation should be used (to avoid tooth decay)

  23. Routes of administrationOral • If the dose is <5ml, dilute it with suitable vehicle to 5ml • Do not prescribe teaspoon doses (dose may vary) • Do not prescribe 1 or 2 tab (mention the strength) • Do not mix it up with food/milk

  24. Routes of administrationRectal • Absorption is erratic • Not preferred method

  25. Routes of administrationTopical • Care should be taken as the drug may be absorbed in significant quantity • Avoid use of topical antibiotics due to danger of sensitization

  26. Routes of administrationParenteral • IM is not preferred -- if necessary outer aspect of thigh is preferred • During IM/IV administration second person should be present to hold the child • Syringe should be prepared out of the child’s sight

  27. Routes of administrationParenteral • Should be prepared for anaphylactic / other untoward reaction • Sterile technique is needed • Alcohol used for cleaning should be allowed to dry before injecting to avoid burning pain

  28. Routes of administrationParenteral • Choose different sites if repeated injections are required • Other than IM/IV, intradermal injection can be considered

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