Calculating, pediatric dose

An order was written for 30 mg Cyclosporine (immunosuppressant) oral solution to be administered to a pediatric patient. However, for several days, the nurse administered 300 mg believing that the syringe was calibrated in mg not mL. The oral solution is available as 100 mg/mL. As the pharmacist reviewed the error, he noted that the syringes accompanying the medication were never designed for pediatrics. It is not possible to calculate any dose less than 50 mg. It is imderstandable how the nurse assumed that the 3 mark was for 30 mg since it is positioned between 2,5 and 3,5 (which are European style for the decimals 2.5 and 3.5). To harmonize products in the global market, the manufacturer chose to follow European convention for expressing numbers which uses commas and decimals in the reverse manner as in the United States. 

The pediatrician calculates the dose based on the infant s weight, choosing the infant dose recommended in a pediatric pharmacology reference text. He prescribes a maintenance dose, given q.i.d. by mouth prior to scheduled feedings, and advises the... 

Most drugs approved for use in children have recommended pediatric doses, generally stated as milligrams per kilogram or per pound. In the absence of explicit pediatric dose recommendations, an approximation can be made by any of several methods based on age, weight, or surface area. These rules are not precise and should not be used if the manufacturer provides a pediatric dose. When pediatric doses are calculated (either from one of the methods set forth below or from a manufacturer s dose), the pediatric dose should never exceed the adult dose. 

Independent calculation of pediatric doses by more than one person (e.g., prescriber and pharmacist)... 

Some pediatric medications are prescribed by weight in kilograms. There are 2.2 lb per kilogram (see Table 7.3). To calculate the pediatric dose you need to know ... 

The usual pediatric dosage range is 2 to 4 mg/kg/day in 2 equally divided doses (eg, 1 to 2 mg/kg twice daily). Dosage calculated by weight generally produces plasma levels in a therapeutic range similar to that in adults. Do not use doses more than 16 mg/kg/day. 

The pediatric medication-use process is complex and error-prone owing to multiple steps required in calculating, verifying, preparing, and administering doses. 

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