Prescribing guidelines for pediatrics

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Prescribing guidelines for treatment of Pediatrics:

Prescribing guidelines for treatment of Pediatrics Prepared & Presented by Dr. Siva Reddy Challa, Professor & HOD, Dept. of Pharmacology KVSR Siddhartha College of Pharmaceutical Sciences, Siddhartha Nagar, Vijayawada-520010 Andhra Pradesh, INDIA Email: sivareddypharma@gmail.com

Pediatric prescribing guidelines : Consideration of physiological factors like age, weight and surface area:

Pediatric prescribing guidelines : Consideration of physiological factors like age, weight and surface area When considering drug use in children, the following age groups should be used: neonate (birth to 1 month), infant (1 month to 2 years), child (2 to 12 years) and adolescent (12-18 years) Check the weight of the pediatric patient Confirm whether weight of the patient is appropriate for the age or not. Check if there is any difference in the weight relative to the age, find out underlying disease (e.g.: cerebral palsy-under weight of the baby). Check if there is a need for calculating the dosage based on surface area. Weight of baby should be re-checked at each treatment before prescribing.

Pediatric prescribing guidelines : Selecting the appropriate dose:

Pediatric prescribing guidelines : Selecting the appropriate dose Check if there is any underlying other diseases before prescribing a drug for presenting disease symptoms. This is important to know the presence of underlying disease that may influence the pharmacokinetics of a drug that the physician is going the give for presenting disease. Children are not mini-adults. Pediatric doses should be obtained from a pediatric dosage reference text like British national formulary for children (BNFC) and not extrapolated from the adult dose.

Pediatric prescribing guidelines : Selecting the appropriate dose:

Pediatric prescribing guidelines : Selecting the appropriate dose Prescribed regimens should be tailored to the child’s daily routine. Where possible, treatment goals should be set in collaboration with child. Dose selection should be appropriate for the pediatric patients. For calculating appropriate dose for pediatric patients, the following formulae are most commonly used. While mentioning the dose in the prescription, Always put a zero in front of the decimal points e.g. 0.5g (better to write 500mg) and hence never omit a zero before the decimal point.

Pediatric prescribing guidelines : Selecting the appropriate dose:

Pediatric prescribing guidelines : Selecting the appropriate dose Do not prescribe liquids in mL unless indicated in BNF (e.g some vitamins may be prescribed by volume). If prescribing in mL, specify the concentration. Always rewrite a prescription when dose or timing altered.

Pediatric prescribing guidelines : Selecting the appropriate dose:

Pediatric prescribing guidelines : Selecting the appropriate dose The formulae used for the calculation of the dose for pediatric patients based on the weight Clark’s formula: Dose = weight in pounds X Average adult dose 50 Fried’s formula: Dose = Age in months X Average adult dose 50 Young’s formula: Dose = Age in years X Adult dose Age + 12

Pediatric prescribing guidelines : Selecting the appropriate dose:

Pediatric prescribing guidelines : Selecting the appropriate dose Calculation by body weight in the overweight child may result in much higher doses being administered than necessary; in such cases, dose should be calculated based on ideal weight, related to height and age. Body surface area estimates are more accurate for calculation of pediatric doses than body weight since many physiological phenomena correlate better to body surface area. Body surface area may be calculated from height and weight by means of a nomogram or using Body surface area (BSA) calculator.

Pediatric prescribing guidelines : Selecting the appropriate dose:

Pediatric prescribing guidelines : Selecting the appropriate dose The formulae used for the calculation of the dose for pediatric patients based on the weight Body surface area (BSA) (m 2 ): √Ht in cm X Wt in kilogram 3600 Pediatric dose calculation based on body surface area: Pediatric dose = B SA of the child X Adult dose 1.73

Pediatric prescribing guidelines : Route of drug admn and timing of admn:

Pediatric prescribing guidelines : Route of drug admn and timing of admn Choose suitable route of administration before prescribing a drug for a pediatric. Wherever possible, painful intramuscular (IM) injections should be avoided in children. Wherever possible, the use of products which avoid the need for administration during school hours should be considered (e.g. modified release preparations with long half lives are preferable). When administration at school is unavoidable, consideration should be given to prescribing and supplying the school time dose in a separate labeled container.

Pediatric prescribing guidelines : consideration of available dosage forms and suitability to the pediatrics :

Pediatric prescribing guidelines : consideration of available dosage forms and suitability to the pediatrics Prescribe the drugs considering the availability of suitable dosage form and ease of administration of the dosage form for a condition of a particular pediatric patient. At times, even though, suitable dosage form is available, physician should consider the safety aspects of excipients used in a particular dosage form before prescribing a particular drug in a particular dosage form. Manipulations can be done with some preparations in order to suit its administration by a particular route.

Pediatric prescribing guidelines : :

Pediatric prescribing guidelines : Predicting the response & Therapeutic drug monitoring Monitoring Pharmacokinetic aspects Check for any possible alterations in pharmacokinetics of a treated drug Monitoring the plasma concentration if any drug related or age related adverse effects are observed.

Pediatric prescribing guidelines : Consideration of drug-drug & food-drug interactions:

Pediatric prescribing guidelines : Consideration of drug-drug & food-drug interactions Before prescribing a drug, physician should examine i) If the patient is already taking medications suggested by previous physician. ii) If the patient was given any medication by the parent before admitting to the hospital. These things are necessary to avoid drug-drug interactions Review of drug interactions in prescribing drugs to pediatric patients is Since, infants are spending most of the time taking milk from mother, prescribing drugs interact with milk are avoided.

Pediatric prescribing guidelines : Consideration of Possible adverse reactions :

Pediatric prescribing guidelines : Consideration of Possible adverse reactions If prescribing drugs, physician not familiar with, check contraindications and side effects. Discuss the known side effects with the parents and ensure that valid consent is sought before administration of unfamiliar drug. Check previous medication history and enquire the parent if patient is previously allergic to any kind of drugs.

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Pediatric prescribing guidelines : Consideration of Legal aspects Before prescribing, check whether the drug is licensed or not for pediatric use. However, The medicines Act 1968 and European legislation make provision for doctors to use medicines in an off label capacity or to use unlicensed medicines. But, individual prescribers are always responsible for ensuring that there is an adequate information to support the quality, efficacy, safety and intended use of a drug before prescribing it.

Pediatric prescribing guidelines : Vaccine prescribing guidelines:

Pediatric prescribing guidelines : Vaccine prescribing guidelines Seek consent before giving any vaccine and ensure that this is noted in the patient record. Ensure all vaccines are recorded accurately, including the date, time, vaccine, batch number as well as site and mode of action.

Child is a like a God. Physician must treat him as though he is treating a God. Of course, Physician is a God in the perspective of the Patient:

Child is a like a God. Physician must treat him as though he is treating a God. Of course, Physician is a God in the perspective of the Patient