TY - JOUR
T1 - Inconsistencies in dosage practice in children with overweight or obesity
T2 - A retrospective cohort study
AU - Gade, Christina
AU - Christensen, Hanne R
AU - Dalhoff, Kim P
AU - Holm, Jens Christian
AU - Holst, Helle
PY - 2018/6
Y1 - 2018/6
N2 - Obesity can affect the pharmacokinetics of most drugs, which may result in under- or overdosing if traditional pediatric dosing strategies are used. To investigate currently applied dosage strategies in children with overweight or obesity (overweight/obesity), in a clinical treatment facility. In particular, whether dosing guidelines were available and metrics of body size applied. A retrospective cohort study of 200 patients admitted to the Danish Children's Obesity Clinic. Data were collected from 2007 to 2015. Overweight/obese children 3-18 years were included if they had at least one drug prescription. Overall there were 658 prescriptions, primarily analgesics, psychotropics, asthma medications, and antibiotics. Except for one prescription, guidelines for dosage of overweight/obese children were not available in the clinic. In one prescription of gentamicin, the dose was adjusted by a metric body size. Otherwise dose was predominately prescribed either by total body weight or as fixed dose by age, in accordance with the recommendations of normal weight children. In drugs with a narrow therapeutic interval, we found large interindividual variations in dosing regimens, that is, for gentamicin, paracetamol, and prednisolone. Reduction of dose to the maximum recommended adult dose was common practice, when the dose calculated by total body weight (ie, mg/kg) exceeded this maximum. This study highlights the shortage of dosing guidelines in overweight/obese children. We found a large interindividual variability in dosage regimens, even in drugs with narrow therapeutic intervals. The clinicians rely on "best practice", as evidence-based dosage regimens are missing for many drugs prescribed during childhood.
AB - Obesity can affect the pharmacokinetics of most drugs, which may result in under- or overdosing if traditional pediatric dosing strategies are used. To investigate currently applied dosage strategies in children with overweight or obesity (overweight/obesity), in a clinical treatment facility. In particular, whether dosing guidelines were available and metrics of body size applied. A retrospective cohort study of 200 patients admitted to the Danish Children's Obesity Clinic. Data were collected from 2007 to 2015. Overweight/obese children 3-18 years were included if they had at least one drug prescription. Overall there were 658 prescriptions, primarily analgesics, psychotropics, asthma medications, and antibiotics. Except for one prescription, guidelines for dosage of overweight/obese children were not available in the clinic. In one prescription of gentamicin, the dose was adjusted by a metric body size. Otherwise dose was predominately prescribed either by total body weight or as fixed dose by age, in accordance with the recommendations of normal weight children. In drugs with a narrow therapeutic interval, we found large interindividual variations in dosing regimens, that is, for gentamicin, paracetamol, and prednisolone. Reduction of dose to the maximum recommended adult dose was common practice, when the dose calculated by total body weight (ie, mg/kg) exceeded this maximum. This study highlights the shortage of dosing guidelines in overweight/obese children. We found a large interindividual variability in dosage regimens, even in drugs with narrow therapeutic intervals. The clinicians rely on "best practice", as evidence-based dosage regimens are missing for many drugs prescribed during childhood.
KW - Adolescent
KW - Analgesics/administration & dosage
KW - Anti-Asthmatic Agents/administration & dosage
KW - Anti-Bacterial Agents/administration & dosage
KW - Child
KW - Child, Preschool
KW - Comorbidity
KW - Denmark
KW - Drug Dosage Calculations
KW - Female
KW - Humans
KW - Male
KW - Overweight/complications
KW - Pediatric Obesity/complications
KW - Practice Guidelines as Topic
KW - Prescription Drugs
KW - Psychotropic Drugs/administration & dosage
KW - Retrospective Studies
U2 - 10.1002/prp2.398
DO - 10.1002/prp2.398
M3 - Journal article
C2 - 29721323
SN - 2052-1707
VL - 6
JO - Pharmacology Research & Perspectives
JF - Pharmacology Research & Perspectives
IS - 3
M1 - e00398
ER -
