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Paracetamol prescribing habits in a children's hospital
B Anderson1, M Anderson, B Hastie
1Department of Intensive Care, Auckland Children's Hospital.
Insights
Many healthcare providers lack clear paracetamol dosing guidelines for infants, leading to unsafe prescribing practices. This study highlights the need for updated recommendations to ensure safe paracetamol use in children, especially neonates.
Area of Science:
- Pediatric Pharmacology
- Clinical Pharmacy
- Drug Safety
Background:
- Paracetamol (acetaminophen) is a common analgesic and antipyretic in children.
- Excessive paracetamol dosage can lead to cumulative toxicity, causing hepatic and renal damage.
- Current dosing guidelines for children under one month of age are lacking.
Purpose of the Study:
- To investigate current paracetamol prescribing habits in pediatric populations.
- To assess the safety of existing paracetamol dosing practices.
- To provide recommendations for rational paracetamol use in children.
Main Methods:
- Anonymous questionnaires distributed to medical staff at a university children's hospital.
- Information gathered on paracetamol prescribing for infants aged 4 months and over, 3 months and under, and neonates within the first two weeks of life.
- Pharmacy audit of inpatient prescription charts to calculate maximum daily doses and identify instances exceeding 95 mg/kg/day.
Main Results:
- A trend towards lower daily paracetamol doses in younger age groups was observed.
- Many practitioners expressed uncertainty regarding safe dosing schedules for infants under 3 months.
- Prescriptions exceeding 95 mg/kg/day were noted in 17% of cases, though actual doses administered were lower due to charting and audits.
Conclusions:
- Uncertainty exists among medical staff regarding safe paracetamol dosing, particularly for younger children.
- Existing guidelines for infants under 3 months are insufficient, with documented underuse of recommended doses.
- Further research is needed to establish optimal paracetamol dosing regimens for neonates to achieve therapeutic concentrations safely.
Aim:
Paracetamol is an analgesic/antipyretic widely used in children. The drug can cause hepatic and renal damage due to cumulative toxicity when used in excess of 90 mg/kg@day. There are no dosing guidelines for paracetamol use in children under 1 month of age. We wished to discern current paracetamol prescribing habits in order to establish safety of current practices and offer recommendations towards rational use.
Methods:
An anonymous questionnaire was sent to all medical staff working in a university childrenís hospital. We sought information about paracetamol prescribing regimes for children 4 months and over, 3 months and under and neonates in the first 2 weeks of life. Pharmacists audited daily prescription charts of inpatients without hepatic or renal disease over a 2 month period. The maximum possible daily dose was calculated for each child and note was made if a dose in excess of 95 mg/kg was given.
Results:
There were 53 respondents to the 80 questionnaires posted. There was a trend to use lower daily doses in the younger age group. Similarly, more practitioners either did not use or did not know safe dosing schedules in children 3 months and younger. During the 2 month period there were 823 prescriptions for children 4 months and over, 85 for infants 3 months and under and seven for under 2 week old neonates. In the children 4 months and over 25 of 140 prescriptions exceeding 95 mg/kg/day were given and two of six were given in infants 3 months and younger.
Conclusion:
Many medical staff were unsure of current safe dosing regimens, particularly in the younger age groups. Seventeen percent of prescriptions were above 95 mg/kg/day although only 3% of children were given these doses due to on demand charting and due to audit by pharmacy and nursing staff. There are few guidelines for children 3 months and under. The literature suggests 60-65 mg/kg/day in infants 1-3 months, although this dose was only charted in 16% of prescriptions and phamacokinetic data favours a higher dose. In neonates 30 mg/kg/day achieves effective therapeutic concentrations but further studies are needed.