Discontinuities and disruptions in drug dosage guidelines for the paediatric population

Abstract

AIMSThis study investigates paediatric drug dosage guidelines withthe aim of investigating their agreement with body surface area(BSA) scaling principles.METHODSA total of 454 drug dosage guidelines listed in the AMH-CDC 2015 were examined. Data extracted included the administration,frequency and dose per age bracket from 0 to 18 years. Drug treatments were categorized as follows: (1) The same dose rec-ommendation in milligrams per kilogram (mg kg 1) for all age/weights; (2) Change in the mg kg 1dosing according toage/weight; (3) Change in dose in mg according to age/weight; (4) Change from mg kg 1dosing to a dose in mg according toage/weight; (5) The same recommendation for all age/weight groups in mg; or (6) BSA dosing. Example drugs were selected toillustrate dose progression across ages.RESULTSMost drug treatments (63%) have the same mg kg 1dose for all age/weight groups, 14% are dosed in mg kg 1across all ageswith dose changes according to age/weight, 13% were dosed in mg across all ages with dose changes, 10% switched frommg kg 1to a set dose in mg, 4.2% have the same dose in mg for all age and weight groups and 2.2% are dosed according to BSA.CONCLUSIONSPaediatric dosage guidelines are based on weight-based formulas, available dosing formulations and prior patterns of use. Sub-stantial variation from doses predicted by BSA scaling are common, as are large shifts in recommended doses at age thresholds.Further research is required to determine if better outcomes could be achieved by adopting biologically based scaling of paedi-atric doses.