Evaluation of inpatient admissions and potential antimicrobial and analgesic dosing errors in overweight children.
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.
Miller
Jamie L
JL
Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, OK 73117, USA. Jamie-Miller@ouhsc.edu
Johnson
Peter N
PN
Harrison
Donald L
DL
Hagemann
Tracy M
TM
D000700:Analgesics / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008508:Medication Errors; D050177:Overweight; D012189:Retrospective Studies
D000700:Analgesics; D000890:Anti-Infective Agents