Evaluating pediatric weight-based antibiotic dosing in a community pharmacy

Owing to pharmacokinetic variations in pediatric patients, many antibiotics require weight-based dosing to ensure medication safety and antimicrobial stewardship. Despite the need for weight-based dosing, prescribers are not legally required to include the weight or diagnosis code on pediatric prescriptions that are necessary components to verify appropriateness. Clinical decision support system (CDSS) can help clinicians improve dosing appropriateness, but little is known about CDSS in a community pharmacy setting. To determine the impact of implementing CDSS in this setting, baseline information is necessary.

This study aimed to determine both the percentage of pediatric antibiotic prescriptions without optimal patient information required to evaluate weight-based dosing and the baseline percentage of prescriptions dosed outside of guideline recommendations.

A retrospective chart review was conducted at a locally owned community pharmacy in rural Southeast Missouri. Prescriptions written for patients less than 18 years old for guideline recommended antibiotics used for acute otitis media or acute pharyngitis dispensed between October 1, 2020, and May 10, 2021, were included in the analysis. Prescriptions were considered optimal if they included both patient weight and diagnosis code. Optimal prescriptions were evaluated for adherence to guideline recommended dosing. The primary outcomes included percentage of prescriptions without patient weight, diagnosis code, or both and the percentage of optimal prescriptions prescribed outside of guideline recommended dosing for the specified condition.

Of the 115 included prescriptions, 45 were missing a patient weight, diagnosis code, or both. Seventy prescriptions were considered optimal, and of those, 42 (60%) were prescribed outside of guideline recommended dosing.

Prescriptions were identified as missing important information at the time of dispensing. Of the optimal prescriptions, the majority were prescribed outside of current guideline recommended dosing, with subtherapeutic dosing being the most common.