超重儿童住院评估及潜在抗菌和镇痛药物剂量错误。

Evaluation of inpatient admissions and potential antimicrobial and analgesic dosing errors in overweight children.

机构信息

Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, OK 73117, USA.

出版信息

Ann Pharmacother. 2010 Jan;44(1):35-42. doi: 10.1345/aph.1M371. Epub 2009 Dec 22.

DOI:10.1345/aph.1M371

PMID:20028958

Abstract

BACKGROUND

The prevalence of overweight/obesity in US children has increased over the past several decades. Routine use of weight-based dosing of medications could potentially result in over- or underdosing in these children.

OBJECTIVE

To determine the percentage of admissions of children with a body mass index (BMI) greater than or equal to the 85th percentile for age and sex and the mean error rate per admission in the overweight versus control group.

METHODS

We performed a retrospective, preliminary study of children aged 5-12 years who were admitted to a children's hospital over a period of 6 months. The overweight group included children with a BMI greater than or equal to the 85th percentile; the control group included children with a BMI less than the 85th percentile. Dose appropriateness was assessed, using 2 references. An overdose was defined as: (1) total mg/kg/day or mg/kg/dose greater than or equal to 110% of the maximum recommended pediatric dose, (2) total mg/day greater than the adult maximum recommended dose, or (3) greater than the recommended number of doses per day. An underdose was defined as: (1) total mg/kg/day or mg/kg/dose less than or equal to 90% of the minimum recommended pediatric dose, or (2) fewer than the recommended number of doses per day. Baseline comparisons between groups were done via Student's t-tests and chi2 analysis, when appropriate, with an a priori alpha of p less than or equal to 0.05.

RESULTS

A total of 839 admissions representing 699 patients were included. The overweight group included 278 (33.1%) admissions. Comparison of overall mean error rate per admission revealed a statistically significant increase in dosing errors for overweight patients (0.4 +/- 0.6 vs 0.3 +/- 0.6; p = 0.030), with underdose errors occurring more frequently than overdose errors (0.3 +/- 0.6 vs 0.2 +/- 0.5; p = 0.010).

CONCLUSIONS

Overweight children accounted for one-third of admissions, and the results of this study suggest that these patients are at greater risk for errors in dosing than are children of age- and sex-appropriate weight. This study did not assess clinical outcomes; however, overweight children could be at increased risk for therapeutic failures or adverse effects.

摘要

背景

在美国，过去几十年儿童超重/肥胖的患病率有所增加。常规使用基于体重的药物剂量可能会导致这些儿童用药过量或不足。

目的

确定身体质量指数（BMI）大于或等于年龄和性别第 85 百分位的儿童入院率和超重组与对照组的平均每入院错误率。

方法

我们对在 6 个月期间入住儿童医院的 5-12 岁儿童进行了回顾性初步研究。超重组包括 BMI 大于或等于第 85 百分位的儿童；对照组包括 BMI 小于第 85 百分位的儿童。使用 2 种参考资料评估剂量适宜性。定义用药过量为：（1）总 mg/kg/天或 mg/kg/剂量大于或等于推荐的最大儿科剂量的 110%；（2）总 mg/天大于成人推荐的最大剂量；或（3）每日剂量大于推荐剂量。定义用药不足为：（1）总 mg/kg/天或 mg/kg/剂量小于或等于推荐的最小儿科剂量的 90%；或（2）每日剂量少于推荐剂量。使用学生 t 检验和适当的卡方分析进行组间基线比较，事先设定 p 值小于或等于 0.05。

结果

共纳入 839 例代表 699 例患者的入院病例。超重组包括 278 例（33.1%）入院病例。总体每入院平均错误率的比较显示，超重患者的用药错误率显著增加（0.4 +/- 0.6 与 0.3 +/- 0.6；p = 0.030），且用药不足错误比用药过量错误更常见（0.3 +/- 0.6 与 0.2 +/- 0.5；p = 0.010）。