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Ibuprofen dosing measurement accuracy using infants' versus children's ibuprofen: a randomized crossover comparison
Emily R Leibovitch1, Alyssa S Fujiwara2, Ian K H Chun2
1Department of Pediatrics, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA. eleibo@hawaii.edu.
Insights
Infant ibuprofen dosing errors were significantly higher than children's ibuprofen. Simplifying concentrations could reduce pediatric medication misdosing and improve patient safety.
Area of Science:
- Pediatric pharmacology
- Medication safety
- Clinical pharmacy
Background:
- Pediatric ibuprofen liquid is available in two concentrations: 200 mg/5 mL for infants and 100 mg/5 mL for children.
- Medication misdosing is a significant issue in pediatric care, particularly with over-the-counter drugs like ibuprofen.
Purpose of the Study:
- To investigate ibuprofen liquid misdosing by comparing administration accuracy across different pediatric concentrations.
- To determine if the infant concentration of ibuprofen leads to greater dosing errors compared to the children's concentration.
Main Methods:
- 116 volunteers participated in the study.
- Participants administered specified doses of both infant and children's ibuprofen concentrations using provided tools.
- Dosing accuracy was measured by comparing the drawn volume to the target dose.
Main Results:
- Mean absolute dosing errors were significantly higher for the infant ibuprofen concentration (39 mg) compared to the children's concentration (27 mg).
- 31% of all ibuprofen dosage experiments resulted in errors exceeding 50% of the assigned dose.
- Dosing errors were more frequent and larger with the infant formulation.
Conclusions:
- The infant concentration of ibuprofen liquid is associated with significantly higher dosing errors.
- Removing the infant-specific concentration could potentially reduce medication misdosing errors in pediatric patients.
- Standardizing to a single concentration may enhance medication safety for children.
Background:
Ibuprofen liquid comes in two pediatric concentrations: 200 mg/5 mL for infants and 100 mg/5 mL for children. This study aimed to investigate the misdosing of ibuprofen liquid products by comparing administration accuracy with differing pediatric concentrations and dosages.
Methods:
Subject selection included 116 volunteers. Participants were provided with the children's ibuprofen package including the dosing cup, the infants' ibuprofen package including the infant dosing dropper, and a 5 mL syringe. Each subject drew up a specified dose of infants' ibuprofen and children's ibuprofen and deposited each sample into a graduated cylinder. The dose (70 or 100 mg) and order of concentration usage (infants' first or children's first) were randomized.
Results:
A total of 116 subjects, with a mean age of 32 ± 14 years, participated in the study. Mean absolute dosing errors for all trials, including those who made no errors, were significantly higher for infants' ibuprofen compared to children's ibuprofen: 39 vs. 27 mg (p = 0.036). A total of 31% of all ibuprofen dosage experiments (71 of 232 trials) had greater than 50% error of the assigned dose.
Conclusion:
Dosage errors using infants' ibuprofen were significantly higher than the children's ibuprofen. This suggests that removing the infant form from consumer availability may help reduce dosing errors when administering ibuprofen to pediatric patients.
Impact:
Pediatric misdosing is a significant problem with over-the-counter medications, such as ibuprofen. A previous study found that 51% of patients under the age of 10 were inaccurately dosed with antipyretic medication, including ibuprofen, with an increased incidence in infants. We found significantly more dosing errors with the infant concentration (200 mg/5 mL) as opposed to the children's concentration (100 mg/5 mL), 39 vs. 27 mg, respectively (p = 0.036). We believe that this research is beneficial to pediatric patient caregivers, clinicians, and policymakers to identify the problem of inaccurate ibuprofen dosing and to propose a way to mitigate this by having one concentration easily accessible.
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