The recent problems in obtaining acetaminophen and to a slightly lesser extent ibuprofen got me to thinking about what common OTC medications would be the next to be in short supply, and so I posted an article on that topic last week. Both of these shortages began with the supply of pediatric formulations of these drugs as well as amoxicillin.
Nothing has happened to alleviate these shortages. Perhaps the situation will improve during the summer when we historically experience fewer illnesses. But really, we’re on a downward trend and it’s best to prepare for things to only get worse. However, they don’t have to be worse for us if we prepare. Funny how that works.
Anyway, only two of my off-grid medicine references include any mention of pediatric drug dosing, and neither one is complete. Fortunately, pediatric medications come with specific dosing instructions as part of the packaging and we can just follow the directions. Unfortunately, we may not have pediatric formulations for what a specific child needs. And we may not have access to a drug dosing guide that specifies the dosage for any given size and illness.
We may have to improvise.
Dr. Cynthia Koelker in her reference Armageddon Medicine indicates that dosing based on weight is preferable, but offers the following information based on age[1]:
|
Approximate pediatric dosing for many medications based on age |
|
|
Ages 12 years and older |
Full adult dose |
|
Ages 6-11 years |
½ adult dose |
|
Ages 2-5 years |
¼ adult dose |
|
Under age 2 years |
1/8 adult dose |
|
Consult a pediatric text for correct dosing of infants, per weight |
|
The authors of Survival and Austere Medicine, 3rd Edition suggest that if you don’t have access to a drug formulary guide, the “20% rule” will help you safely dose children. They indicate that by using this guideline, children will not be overdosed. In fact, with some drugs, particularly antibiotics, where a bigger fraction of the adult dose is generally used, they may be slightly under-dosed. This is, however, the safest approach when not completely sure of the right pediatric dose.[2]
|
Approximate pediatric dosing for many medications based on weight |
|
|
10 kg (22 lbs) |
20% of the adult dose |
|
20 kg (44 lbs) |
40% of the adult dose |
|
30 kg (66 lbs) |
60% of the adult dose |
|
40 kg (88 lbs) |
80% of the adult dose |
|
50 kg (110 lbs) |
100% of the adult dose |
Keep in mind that children are not little adults. The medical specialty of pediatrics exists for good reason. Children possess an accelerated metabolism. Growth and maturation of organs may be affected by drugs (some drugs will stain their teeth). There is less allowance for dosing errors, especially in infants.
The authors of Survival and Austere Medicine note that the only common exception is penicillin-based antibiotics (this includes amoxicillin). This class of antibiotics is eliminated very well by the body and so the above values are doubled. However, while Augmentin is also in the penicillin class (it is amoxicillin plus clavulanic acid), it is never doubled or halved as the clavulanic acid component is always the same.
[1] Cynthia Koelker, Armageddon Medicine, 260.
[2] Survival and Austere Medicine, 3rd Edition, 292.
not sure about the current supply situation - but the $$ Dollar Stores used to have packages of combo spoon & eye dropper in the baby aisle - measuring marks for exact dosing ....
ReplyDelete