What is the right dose for children?

Residual volume in vials of antibiotics used in pediatrics

“…As the most consistent bedside care providers, nurses have an ideal position to improve antibiotic management through multidisciplinary collaboration, optimizing treatment, monitoring and administration, while improving pediatric patient safety and quality of care (11) . The lack of parenteral drugs in adequate presentation for pediatrics represents a worldwide problem, constituting one of the factors that most contributes to the reuse of these medicines and also to increased care costs (13)(14) . The waste of antibiotics evidenced by the existence of residual volume reinforces another worrying finding, which is the inadequate disposal of the vials containing residual volumes of medicines.…”

Medicines for children: Rationale and recent advances

“…For example, a paediatric dose is traditionally based on body weight. This paradigm is challenged now [33,34,35] Adjusting paediatric doses based on any demographic covariate is questioned as there is lack of evidence on how these factors affect drug exposure in children [36]. Continuing this practice with lack of evidence always runs the risk of administering unsafe or ineffective paediatric doses.…”

“…This is critical for medicines with a narrow therapeutic index and medicines which exhibit steep dose-response curves. Potential sources of pharmacokinetic differences in the paediatric population include age, gender, body-composition, concentration of plasma proteins, liver blood flow, liver function, glomerular filtration rate and, most importantly, ontogeny (development and maturation of metabolic pathways) [34,36]. The latter four factors have a significant influence on drug elimination which is the important pharmacokinetic component which determines drug exposure * .…”

“…However, none of these parameters change proportionally with age, weight or even body surface area [34,36]. Thus, the relationship between these demographic covariates and dose cannot always be linear.…”

Therapeutic drug monitoring of carbamazepine and its metabolite in children from dried blood spots using liquid chromatography and tandem mass spectrometry

“…As for the most drugs, those hampers are inadequately handled by calculating the dose regimens from PK data obtained in adults and normalization of the adult dose according to child's age and body weight/area. This approach leads to poor and unsafe estimates of the paediatric dose [12,13].…”