Inconsistencies in dosage practice in children with overweight or obesity: A retrospective cohort study

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 -