Don't use them as genuine average weights for age in other situations. You will need Adobe Acrobat Reader. This tool is designed to be a readily available guide to endotracheal tube sizes and positions,and to doses of drugs and other therapies. It is not a recipe book -it is important that you think carefully if "standard" doses of drugs are appropriate for any individual patient, especially acutely unstable ones. Do not just blindly follow the doses given here - think first.
Information presented here comes from several sources, particularly Drug Doses by Frank Shann. Doses have been rounded where sensible to do so, and minimum and maximum doses applied to some drugs. For Morphine, Fentanyl, Thiopentone and Propofol it is important to titrate the dose for its desired effect.
Be verycautious of hypotension in sick children and respiratory depression if not ventilated. Be careful in patients with haemodynamic compromise - cardiac failure, pulmonary hypertension, septic shock. Correct hypovolaemia first. I've done my best to ensure this information is accurate and cross checked doses with other experts but it is your responsibility to verify doses etc before using this tool.
The weight, height, age and Body Surface Area records of the children were employed for calculation of the pediatric drug dosages with utilization of the Clark's 13 , Salisbury 8 and Penna's 10 rules and the Body Surface Area BSA 3. Graphs of weight-height development were considered for evaluation of the normality of children of male and female genders in relation to weight and height Calculation of the dosages was performed for each child by utilization of the rules mentioned in Table 1 and frequently found in the literature.
The pediatric dosages achieved were compared to the predetermined dosages in mg kg -1 , herein named standard dosages, also calculated for each child. The parents during the interview reported these drugs as the most frequently prescribed by pediatric dentists for elimination of pain, inflammation and infectious processes of the oral cavity. The standard dosages for antibiotics are mentioned in the literature as minimum and maximum Table 2.
Therefore, this was taken into account for comparison between the rules, since the clinically acceptable pediatric dosages should fall within the minimum and maximum values.
All dosages calculated in the present study were pooled and evaluated to verify whether there is a difference in the dosages obtained by utilization of the four rules and the standard dosage mg kg -1 , even for the pediatric patient. Moreover, the statistical significance was calculated, and the possible clinical significance of the differences found was discussed, since the dosages achieved by application of the rules were not clinically tested so far. Determination of the viability of the rules was based on the statistical data. The mean dosages obtained by the rules were compared for each drug and for each study group, for a better understanding of the outcomes.
Both formulas displayed the same outcomes compared to the standard dosages. From a clinical standpoint, the Dipyrone dosages obtained by the Clark's rule and employed for pain control in the pediatric patient would be much below the therapeutic standard dosage recommended in the 3 study groups Figure 1. The clinical effect desired may not be achieved with such dosages, yet further investigations with clinical tests should be performed. Concerning the anti-inflammatory drugs employed in the present study, incoherent outcomes were found upon comparison of the Clark and standard dosages.
Further investigations would be required to check maintenance of the clinical effects with the statistically different Clark dosages for both Nimesulide and Diclofenac. However, it may be observed that the Diclofenac dosages were not above the dosage of 2mg kg -1 , 15 regarded as the maximum ideal dosage, for Groups 1 and 2; nor were they higher than 50mg, which is the adult dosage recommended, for Group 3. Evaluation of the drugs Paracetamol and Diclofenac in the 3 study groups reveals a statistically significant difference between the values achieved for the Salisbury and standard dosages.
However, the Diclofenac dosages were not higher than 2mg kg -1 , 15 , for Groups 1 and 2; nor were they higher than 50mg for Group 3 Figure 2. For more security, additional studies should be conducted to verify maintenance of the clinical effects with the dosages found without the risk of exacerbated or toxic side effects to the pediatric patient.
The behavior of Dipyrone and Nimesulide was similar in all three studies groups.
The Royal Children's Hospital : Drug Doses - CPG
Clinically, the Salisbury dosages for Dipyrone and Nimesulide would be below the therapeutic standard dosage recommended therefore, such dosages might not yield a satisfactory clinical response. As regards to Amoxicillin Figure 3 and Erythromycin, a similar behavior was observed for all three studies groups. The Salisbury dosages of these drugs might be employed for infection control in the pediatric patient, since they would be within the therapeutic dosages recommended, i.
According to Lack and Stuart-Taylor 8 , the Salisbury rule allows easy calculations, and ten-year investigations have revealed no clinical evidence of improper dosages. In the authors' opinion, such rule may be employed instead of the BSA in specific situations, since in accordance with Walson, et al.
The Salisbury dosages calculated in Groups 1 and 2 were always lower than the BSA dosages and presented significant differences for all drugs. These results reveal discordant data compared to those found by Lack and Stuart-Taylor 8 , who demonstrated similar dosages between the Salisbury and BSA dosages and thus indicate utilization of the first because of the easier calculation. Paracetamol, Dipyrone, Diclofenac and the antibiotics evaluated presented a similar behavior in three groups. Clinically, the Dipyrone dosages achieved by the BSA formula that would be employed for pain control in the pediatric patient are assumed to be much below the therapeutic standard dosage recommended, not being able to provide proper clinical response.
Paracetamol presented BSA dosages much above the therapeutic dosage recommended Figure 4. Such dosages exceeded or were much close to the hepatotoxic dosage of the drug, especially in groups 1 and 2, upon individual comparison of the children. Verification of the maintenance of the clinical effects with the dosages found without the risk of exacerbated or toxic side effects to the pediatric patient is required. As regards to Diclofenac, the drug dosages obtained by the BSA formula that would be employed for control of inflammation in the pediatric patient are higher than the therapeutic standard dosage recommended and did not exceed the ideal maximum dosage of 2mg kg -1 , 15 , in groups 1 and 2.
Incoherent outcomes were found for Nimesulide Figure 5. For Amoxicillin and Erythromycin Figure 6.
Despite the statistically significant difference between the standard and BSA dosages, the antibiotic dosages achieved by the BSA formula might be effective for clinical infection control, since they are within the therapeutic dosages recommended. The results found in the present study for the antibiotics partially confirm the report of Tavares 20 , who stated that the dosages, especially of these drugs, should be calculated on the basis of the child's weight.
However, it may be observed that calculation based on the BSA is also acceptable. According to Robinson and Williams 16 , these two methods for dosage calculation are favorable for establishment of the proper pediatric dosage. The authors confirm the outcomes found in the present study, highlighting that both methods not always yield the same drug dosage. However, they present a different opinion on the present results, stating that the differences between the dosages achieved by weight and by the Body Surface Area are larger in younger children.
- C&W Online Formulary.
- Related Content.
- Clinical Practice Guidelines : Emergency drug doses - CPG.
- Minimizing Medication Errors in Pediatric Patients;
- Pediatric Dosage Calculations | Davis's Drug Guide.
In the opinion of Rodman 17 , the pediatric dosages adjusted by the BSA are substantially higher than the dosages adjusted by body weight, as observed for the drugs Paracetamol and Diclofenac in the three study groups. Results similar to those obtained by utilization of the BSA formula were found by application of the Penna's rule, when both were compared to the standard dosage. Such findings corroborate the report of Marcondes 10 , who suggested that the Penna's rule follow the body surface.
Pediatric Drug Dosages
The present study demonstrated that the Penna dosages were always higher than the BSA dosages, even though this difference was not statistically significant for some drugs. Nevertheless, the Penna dosages achieved for Paracetamol exceeded or were close to the hepatotoxic dosage of the drug, 6 especially in Groups 1 and 2. As regards to Diclofenac and Dipyrone, the results were similar to those achieved by the BSA formula. As to the antibiotics, the Penna dosages were higher than the BSA dosages, yet they were not statistically different from the maximum standard dosages recommended for such drugs.
Emergency drug doses - CPG
Despite the higher dosages achieved, the Penna's rule was quite similar to the BSA formula, with the advantage of simpler application. It provided acceptable utilization in Pediatric Dentistry, since there are few reports of toxicity of these antibiotics. Fundamentos de farmacologia. Paracetamol for fever in children. Australian Family Phisician. Calculation of drug dosage and body surface area of children.