Paracetamol prescribing habits in a children's hospital.
OBJECTIVE
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.


CONCLUSIONS
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.
Department of Intensive Care, Auckland Children's Hospital.
B
B
Anderson
M
M
Anderson
B
B
Hastie
D000082:Acetaminophen / Q000627:therapeutic use*; D000367:Age Factors; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D001835:Body Weight; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006744:Hospital Bed Capacity, 100 to 299; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000193:education / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen