Adequacy of recommended aminophylline loading doses in children

Area of Science:

• Pediatric Pulmonology
• Clinical Pharmacology
• Asthma Management

Background:

• Reactive airway disease, including asthma, is common in children.
• Aminophylline is frequently used for acute asthma exacerbations.
• Optimal dosing strategies for pediatric patients require further investigation.

Purpose of the Study:

• To evaluate the adequacy of a 6 mg/kg intravenous aminophylline loading dose in hospitalized pediatric patients.
• To determine serum theophylline concentrations and the need for additional bolus doses.
• To identify patient factors influencing theophylline levels.

Main Methods:

• Prospective study of pediatric patients (6 months to 14 years) with reactive airway disease.
• Administration of a 5-7 mg/kg intravenous aminophylline loading dose followed by continuous infusion.
• Monitoring of serum theophylline concentrations and clinical status to guide additional dosing.

Main Results:

• 72% of patients had subtherapeutic theophylline levels (< 10 mg/L) within 5.5 hours.
• 78% required at least one additional bolus dose.
• Younger children (≤5 years) and males were more likely to have subtherapeutic concentrations.

Conclusions:

• A 6 mg/kg intravenous aminophylline loading dose is inadequate for most pediatric patients with acute asthma.
• Additional bolus doses are frequently necessary to achieve therapeutic serum theophylline concentrations.
• Age and sex are significant factors affecting theophylline levels in pediatric asthma patients.