Precision Dosing in Children

Asking More of Our EHR Systems to Improve Outcomes for Pediatric Patients

“…What would it look like to realize the work of Mould et al (Barrett et al, 2008;Mould et al, 2014Mould et al, , 2018Hawcutt et al, 2016;Strik et al, 2018Strik et al, , 2019 in a more meaningful and sustainable way? Fundamentally, this will require more engaged hospital governance committees comfortable with technology, underlying models and the quality of the data collected in conjunction with a culture that is more open to seeing technology built on EHRs as an extension of their practice and not a mere record keeping or billing service.…”

“…Precision medicine in pediatrics will require an appropriate evidence base (particularly for unlicensed and off label medications), with relevant patient-specific data (e.g., genotype, environmental, and lifestyle data) added to guide both medication selection and the dose required (Hawcutt et al, 2016). The choice of the source of this data should not be the issue as long as it possesses the appropriate information value.…”

Aminophylline Dosage In Asthma Exacerbations in Children: A Systematic Review

“…Few studies primarily investigate the optimum dosing strategies in children [ 18 ] Therefore, we used a systematic review technique which anticipates various study designs, similar to the methodology we recently used to examine the evidence around therapeutic ranges for aminophylline [ 17 , 19 ]. We decided a priori that the most relevant study type would be a comparison of randomised controlled trials (RCTs) comparing different dosing strategies and measuring clinically relevant outcomes, but we would also include RCTs evaluating the efficacy of intravenous theophyllines compared with placebo or other treatment, with subsequent analyses performed for each comparator drug, and observational studies.…”

Solving the problem of dose optimization of children’s medicines

“…Age bands are easy to use in clinical practice, but can be very inaccurate, and requires the drug in question to have a wide therapeutic index to be safe [28]. IBW and LBW may have advantages for drugs that are predominantly intravascular, but there are few dose optimization studies comparing actual weight with either ideal or lean body weight in children.…”

“…BSA may have advantages over actual body weight, but can over-predict clearance in neonates, while the more complex calculation makes it harder to use in routine clinical practice [29]. Allometric scaling is superior to actual body weight and BSA for scaling some pharmacokinetic (PK) parameters such as plasma clearance, volume of distribution and elimination half-life, but is a very complex calculation that is not routinely used in clinical practice [28,30].…”