Time for a drug dose update to deal with supersized children

Medicines experts are calling for a review of the 50-year-old guidelines on prescribing antibiotics to children, warning that the rise in overweight and obese youngsters may mean that some get a less than adequate dose. While they stress that there is no evidence that children are suffering as a result of under-treatment, they say there should be better guidance than the rule of thumb that has applied for half a century.

Since the 1960s, doctors have worked on the principle that a big child is equal to half an adult, a small child is equal to half a big child and a baby is equal to half a small child, say a group of doctors and scientists in the British Medical Journal.

The problem lies with the prescription of oral penicillin, such as amoxicillin which is widely used against bacterial infections in children. They make up 4.5m of the total 6m annual antibiotic prescriptions for children…

If children get less than the dose they need, there is a possibility that their infection will not clear up easily. It also raises the risk of antibiotic resistance developing. If the bug is not successfully eliminated by the antibiotic, it may mutate into a new form that is resistant to the drug – and be passed on to other children.

Dr Paul Long, senior lecturer in pharmacognosy at King’s College London, who is one of the authors, said: ‘We were surprised at the lack of evidence to support the current oral penicillins dosing recommendations for children, as it is such a commonly used drug. Children’s average size and weight are slowly but significantly changing, so what may have been adequate doses of penicillin 50 years ago are potentially not enough today.

“It is important to point out that this study does not provide any clinical evidence that children are receiving sub-optimal penicillin doses that lead to harm, and we want to reassure parents of that. But what we are saying is that we should ensure that children with severe infections who need these antibiotics the most are still receiving an effective dose …

I’ve had this discussion with local physicians over the last couple of years. Mostly, it evokes mild – and short-lived – curiosity.

As practicing GP’s they haven’t the time for detailed and scientific studies. They’ll wait for the evidence and recommendations from peer-reviewed journals, medical associations. Still, it sounds as if it’s time for some serious research on the topic. Since we’re stuck into growing obesity as thoroughly as declining education.

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