Evaluating pediatric weight-based antibiotic dosing in a community pharmacy

Area of Science:

• Pharmacology and Pharmaceutics
• Pediatric Medicine
• Health Informatics

Background:

• Pediatric antibiotic dosing often requires weight-based calculations due to pharmacokinetic variations.
• Current regulations do not mandate weight or diagnosis codes on pediatric prescriptions, hindering appropriateness verification.
• Clinical decision support systems (CDSS) show promise for improving antibiotic dosing but their use in community pharmacies is understudied.

Purpose of the Study:

• To assess the prevalence of pediatric antibiotic prescriptions lacking optimal patient information (weight, diagnosis code).
• To determine the baseline percentage of these prescriptions that are outside guideline-recommended dosing.
• To establish a baseline for evaluating the potential impact of CDSS in community pharmacy settings.

Main Methods:

• A retrospective chart review of pediatric antibiotic prescriptions at a community pharmacy.
• Included antibiotics for acute otitis media or pharyngitis dispensed between October 2020 and May 2021.
• Defined optimal prescriptions as those including both patient weight and diagnosis code; evaluated dosing against guidelines.

Main Results:

• Out of 115 prescriptions, 45 (39%) lacked patient weight, diagnosis code, or both.
• Seventy prescriptions were deemed optimal.
• Of the optimal prescriptions, 42 (60%) were dosed outside guideline recommendations, often subtherapeutically.

Conclusions:

• A significant proportion of pediatric antibiotic prescriptions are missing crucial information for dosing verification.
• The majority of optimal prescriptions were found to be outside guideline-recommended dosing, indicating potential safety and efficacy issues.
• Findings underscore the need for interventions, such as CDSS, to improve pediatric antibiotic prescribing in community pharmacies.