Facilitate Treatment Adjustment After Overdosing: Another Step Toward 21st-Century Medicine.
Overdosing occurs frequently because of prescription errors in neonates, infants, children, adolescents, and adults. Currently there is no quantitative approach that can be used by clinicians to adjust dosing so that toxic drug concentrations can be brought back to levels observed with safe and efficacious therapeutic doses. We present a mathematical solution that offers the time between last overdosing and next therapeutic dose to achieve therapeutic drug concentrations as soon as possible. To facilitate applications of this solution in clinical practice, a minimal amount of information has to be provided, and no simulations are necessary to compute the optimal waiting time. For educational purposes, we provide access to an online decision support tool for overdosing situations (Time to next Dose Calculator) that (1) computes the waiting time after accidental overdosing in patients with normal elimination and (2) computes the waiting time and adjusted reference dosing for patients with abnormal elimination. This user-friendly online tool will help clinicians to quickly adjust a dosing schedule in overdosing situations to mitigate risk for negative clinical consequences.
Paediatric Pharmacology and Pharmacometric, University of Basel, Children's Hospital, Basel, Switzerland.
Gilbert
G
Koch
Department of Mathematics and Statistics, University of Konstanz, Konstanz, Germany.
Johannes
J
Schropp
Paediatric Pharmacology and Pharmacometric, University of Basel, Children's Hospital, Basel, Switzerland.
Marc
M
Pfister
D000583:Amikacin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D062787:Drug Overdose; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008508:Medication Errors; D008954:Models, Biological; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000378:metabolism; D051437:Renal Insufficiency / Q000378:metabolism / Q000503:physiopathology; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics
D000900:Anti-Bacterial Agents; D004364:Pharmaceutical Preparations; D014640:Vancomycin; D000583:Amikacin
dose adjustment; overdosing; pharmacokinetics; prescribing errors; therapeutic dose