Gaps in Drug Dosing for Obese Children: A Systematic Review of Commonly Prescribed Emergency Care Medications.
OBJECTIVE
Approximately 1 of 6 children in the United States is obese. This has important implications for drug dosing and safety because pharmacokinetic (PK) changes are known to occur in obesity due to altered body composition and physiologic mechanisms. Inappropriate drug dosing in an emergency setting can limit therapeutic efficacy and increase drug-related toxic effects for obese children. Few systematic reviews examining PK properties and drug dosing in obese children have been performed.


METHODS
We identified 25 emergency care drugs from the Strategic National Stockpile and Acute Care Supportive Drugs List and performed a systematic review for each drug in 3 study populations: obese children (2-18 years of age), normal weight children, and obese adults (aged >18 years). For each study population, we first reviewed a drug's Food and Drug Administration label and then performed a systematic literature review. From the literature, we extracted drug PK data, biochemical properties, and dosing information. We then reviewed data in 3 age subpopulations (2-7 years, 8-12 years, and 13-18 years) for obese and normal weight children and by route of drug administration (intramuscular, intravenous, oral, and inhaled). If sufficient PK data were not available by age and route of administration, a data gap was identified.


RESULTS
Only 2 of 25 emergency care drugs (8%) contained dosing information on the Food and Drug Administration label for obese children and adults compared with 22 of 25 (88%) for normal weight children. We found no sufficient PK data in the literature for any of the emergency care drugs in obese children. Sufficient PK data were found for 7 of 25 emergency care drugs (28%) in normal weight children and 3 of 25 (12%) in obese adults.


CONCLUSIONS
Insufficient information exists to guide dosing in obese children for any of the emergency care drugs reviewed. This knowledge gap is alarming, given the known PK changes that occur in the setting of obesity. Future clinical trials examining the PK properties of emergency care medications in obese children should be prioritized.
Department of Pediatrics, Duke University, Durham, North Carolina.
Stevie
S
Rowe
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
David
D
Siegel
Department of Pediatrics, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. Electronic address: Danny.Benjamin@dm.duke.edu.
Daniel K
DK
Benjamin
D002648:Child; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D004632:Emergency Medical Services / Q000379:methods; D006801:Humans; D063766:Pediatric Obesity / Q000378:metabolism*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010599:Pharmacokinetics; D014481:United States; D014486:United States Food and Drug Administration
D004364:Pharmaceutical Preparations
children; emergency care; obesity; pharmacokinetics